EUS-CDS Results in Fewer Cases of PPP

Background: Endoscopic retrograde cholangiopancreatography (ERCP) is commonly used to drain a common bile duct (CBD) obstructed by cancer. However, a newer procedure, endoscopic ultrasound-guided choledochoduodenostomy (EUS-CDS), avoids cannulation of the ampulla of Vater and may prevent some cases of postprocedure pancreatitis (PPP). Objective: To compare EUS-CDS with ERCP for malignant CBD obstruction. Design: Randomized clinical trial (RCT). Participants: Adults with obstructed CBDs due to malignancy. Methods: Adults with malignant CBD obstructions were randomized to undergo either EUS-CDS or ERCP. All patients received IV fluids and rectal indomethacin as prophylaxis against PPP. They were followed up for 6 months unless clinical symptoms occurred earlier. The primary outcome was PPP, defined as new-onset or increased upper abdominal pain, pancreatic enzyme levels >3 times normal, and hospitalization lasting >2 days. Secondary outcomes included successful biliary drainage, decrea more...