ERCP is currently the primary treatment method for biliary obstruction in pancreatic cancer, while EUS-guided biliary drainage (EUS-BD) is considered for decompression only as a rescue technique after failed ERCP.
In a randomised trial on EUS-BD vs. ERCP as primary treatment for distal biliary obstruction in pancreatic cancer, the team of Shyam Varadarajulu has found that there was no significant difference in the rate of adverse events between the two groups (21.2% with 6.1% moderate severity in the EUS-BD vs. 14.7% with 5.9% in the ERCP group), no difference in the rates of technical success (90.9% vs 94.1%, p = .67), treatment success (97% vs 91.2%, p = .61) or reinterventions (3.0% vs 2.9%, p = .99).
Considering the results above, the authors conclude that EUS-BD could be a practical , fluoroscopy-free alternative to ERCP for primary biliary decompression in pancreatic cancer.
We should however take into account that the study was performed in an expert endoscopy center and also that it was powered to detect a large difference in adverse events rates between EUS-BD and ERCP, as suggested by the literature (assumed adverse events rate – 5% for ERCP and 32% for EUS-BD).