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Year : 2018  |  Volume : 7  |  Issue : 1  |  Page : 48-55

Patient perception and preference of EUS-guided drainage over percutaneous drainage when endoscopic transpapillary biliary drainage fails: An international multicenter survey

1 Department of Internal Medicine, Dankook University College of Medicine, Cheonan, South Korea
2 Division of Gastroenterology, Department of Internal Medicine, Biomedical Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, South Korea
3 Department of Internal Medicine, Soonchunhyang University School of Medicine, Cheonan, South Korea
4 First Department of Internal Medicine, Gifu University Hospital, Gifu, Japan
5 Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
6 Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
7 Department of Gastroenterology and Hepatology, IRYCIS, University Hospital Ramon y Cajal, Móstoles, Madrid, Spain
8 Department of Gastroenterology and Hepatology, Rio Hortega University Hospital, Valladolid, Spain
9 Division of Gastroenterology and Hepatology, The University of California Irvine Health, Orange, CA, USA
10 Department of Internal Medicine, Division of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea

Correspondence Address:
Dr. Do Hyun Park
Department of Internal Medicine, Division of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-Gil, Songpa-gu, Seoul 05505
South Korea
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/eus.eus_100_17

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Background and Objectives: EUS-guided biliary drainage (EUS-BD) is a feasible procedure when ERCP fails, as is percutaneous transhepatic BD (PTBD). However, little is known about patient perception and preference of EUS-BD and PTBD. Patients and Methods: An international multicenter survey was conducted in seven tertiary referral centers. In total, 327 patients, scheduled to undergo ERCP for suspected malignant biliary obstruction, were enrolled in the study. Patients received decision aids with visual representation regarding the techniques, benefits, and adverse events (AEs) of EUS-BD and PTBD. Patients were then asked the choice between the two simulated scenarios (EUS-BD or PTBD) after failed ERCP, the reasons for their preference, and whether altering AE rates would influence their prior choice. Results: In total, 313 patients (95.7%) responded to the questionnaire and 251 patients (80.2%) preferred EUS-BD. The preference of EUS-BD was 85.7% (186/217) with EUS-BD expertise, compared to 67.7% (65/96) without EUS-BD expertise (P < 0.001). The main reason for choosing EUS-BD was the possibility of internal drainage (78.1%). In multivariate analysis, the availability of EUS-BD expertise was the single independent factor that influenced patient preference (odds ratio: 3.168; 95% of confidence interval, 1.714–5.856; P < 0.001). The preference of EUS-BD increased as AE rates decreased (P < 0.001). Conclusions: In this simulated scenario, approximately 80% of patients preferred EUS-BD over PTBD after failed ERCP. However, preference of EUS-BD declined as its AE rates increased. Further technical innovations and improved proficiency in EUS-BD for reducing AEs may encourage the use of this procedure as a routine clinical practice when ERCP fails.

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