Single-stage EUS-guided choledochoduodenostomy using a lumen-apposing metal stent for malignant distal biliary obstruction.

Published on Jan 1, 2019in Gastrointestinal Endoscopy9.427
· DOI :10.1016/J.GIE.2018.08.047
Andrea Anderloni29
Estimated H-index: 29
,
Alessandro Fugazza17
Estimated H-index: 17
+ 8 AuthorsAlessandro Repici75
Estimated H-index: 75
(Humanitas University)
Sources
Abstract
Background and Aims EUS-guided choledochoduodenostomy (EUS-CD) using a lumen-apposing metal stent (LAMS) has recently been reported as an alternative treatment approach for patients with malignant obstructive jaundice and failed ERCP. We analyzed the safety and technical and clinical efficacy of EUS-CD using LAMSs in patients with malignant obstructive jaundice. Methods This was a retrospective study of consecutive patients with inoperable malignant distal bile duct obstruction who underwent EUS-CD using an electrocautery-enhanced (EC)-LAMS over a 3-year period (2015-2018). The main outcome measures were technical and clinical success (defined as a decline in serum bilirubin level by 50% at 2-week follow-up). Secondary outcomes were occurrence of adverse events, procedure time, and stent patency. Results Forty-six patients (47.8% women; median age, 73.1 ± 12.6 years) underwent direct EUS-CD using the biliary EC-LAMS. The procedure was technically successful in 43 patients (93.5%). The rate of clinical success was 97.7%. Adverse events occurred in 5 (11.6%) patients and included the following: 1 fatal bleeding 17 days after stent placement, 3 episodes of stent occlusion (food impaction), and 1 spontaneous migration (all 4 requiring reintervention). The mean follow-up was 114.37 days (95% confidence interval, 73.2-155.4). Conclusions EUS-CD using the EC-LAMS is effective. The rate of adverse events including one fatal event is not negligible and should be carefully considered before using the stent in this clinical setting. Prospective studies are required to validate our preliminary findings to fully assess the long-term efficacy and safety of the stent.
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References25
Newest
#1Bryan Brimhall (Anschutz Medical Campus)H-Index: 3
#2Samuel Han (Anschutz Medical Campus)H-Index: 13
Last. Raj J. Shah (Anschutz Medical Campus)H-Index: 47
view all 11 authors...
Background & Aims There have been few studies that compared the effects of lumen-apposing metal stents (LAMS) and double-pigtail plastic stents (DPS) in patients with peripancreatic fluid collections from pancreatitis. We aimed to compare technical and clinical success and adverse events in patients who received LAMS vs DPS for pancreatic pseudocysts and walled-off necrosis. Methods We performed a retrospective study of endoscopic ultrasound–mediated drainage in 149 patients (65% male; mean age,...
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#6Dong-Wan Seo (Asan Medical Center)H-Index: 13
Objectives Interventional endoscopic ultrasonography (EUS) procedures are gaining popularity and the most commonly performed procedures include EUS-guided drainage of pancreatic pseudocyst, EUS-guided biliary drainage, EUS-guided pancreatic duct drainage and EUS-guided celiac plexus ablation. The aim of this paper is to formulate a set of practice guidelines addressing various aspects of the above procedures. Methods Formulation of the guidelines was based on the best scientific evidence availab...
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#1Ji Young Bang (Florida Hospital Orlando)H-Index: 29
#2Udayakumar Navaneethan (Florida Hospital Orlando)H-Index: 50
Last. Shyam Varadarajulu (Florida Hospital Orlando)H-Index: 73
view all 5 authors...
Background and Aims Studies on EUS-guided transmural biliary drainage (EUS-BD) have evaluated its efficacy as a rescue technique after failed ERCP. We performed a single-center, single-blind, randomized trial to compare EUS-BD and ERCP as primary treatment for distal biliary obstruction in pancreatic cancer. Methods Patients underwent EUS-BD (n = 33) or ERCP (n = 34). The primary endpoint was the rate of adverse events. Secondary endpoints were technical success, treatment success (defined as de...
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#1Andrea Anderloni (Humanitas University)H-Index: 29
#2Alessandro Fugazza (Humanitas University)H-Index: 17
Last. Alessandro Repici (Humanitas University)H-Index: 75
view all 8 authors...
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#1Francisco Javier García-Alonso (University of Valladolid)H-Index: 8
Last. Manuel Perez-MirandaH-Index: 24
view all 9 authors...
Background: Delayed gastrointestinal (GI) bleeding and stent migration are known adverse events which may occur following placement of lumen-apposing metal stents (LAMSs). Methods: All consecutive patients who underwent LAMS placement between May 2011 and June 2017 at a single tertiary medical center were included. Demographics and procedural details were prospectively collected. Post-procedure follow-up and outcome measures were retrospectively collected. The cumulative risks of migration and L...
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#1Takayoshi Tsuchiya (TMU: Tokyo Medical University)H-Index: 34
#2Anthony Yuen Bun Teoh (CUHK: The Chinese University of Hong Kong)H-Index: 33
Last. Masayuki Kitano (Kindai University)H-Index: 43
view all 8 authors...
Background and Aims EUS-guided choledochoduodenostomy (EUS-CDS) using conventional tubular stents has been successfully performed. However, EUS-CDS carries a high risk of bile leakage with attendant adverse events. This study aimed to prospectively evaluate the long-term outcome of EUS-CDS using a dedicated lumen-apposing metal stent (LAMS). Methods Nineteen patients (mean age, 70.6 years; 12 men) with unresectable malignant diseases were treated in 5 tertiary referral centers. EUS-CDS was perfo...
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#2Muhammad Ali Khan (UTHSC: University of Tennessee Health Science Center)H-Index: 22
Background and Aims EUS-guided biliary drainage (EUS-BD) is increasingly used as an alternate therapeutic modality to percutaneous transhepatic biliary drainage (PTBD) for biliary obstruction in patients who fail ERCP. We conducted a systematic review and meta-analysis to compare the efficacy and safety of these 2 procedures. Methods We searched several databases from inception to September 4, 2016 to identify comparative studies evaluating the efficacy and safety of EUS-BD and PTBD. Primary out...
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#1Harsha Moole (UIC: University of Illinois at Chicago)H-Index: 12
#2Matthew L. BechtoldH-Index: 29
Last. Srinivas R. PuliH-Index: 15
view all 4 authors...
AbstractBackground:In patients with inoperable malignant biliary strictures, endoscopic retrograde cholangiopancreatography (ERCP) guided biliary stenting fails in 5% to 10% patients due to difficult anatomy/inability to cannulate the papilla. Recently, endoscopic ultrasound guided biliary drainage
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#1Andrea AnderloniH-Index: 29
#2Fabia Attili (CUA: The Catholic University of America)H-Index: 16
Last. Alberto Larghi (CUA: The Catholic University of America)H-Index: 32
view all 9 authors...
Background Recently, a novel lumen-apposing fully covered self-expanding metal stent (LA-FCSEMS) mounted on an electrocautery-enhanced delivery system has been developed to perform endoscopic ultrasound (EUS)-guided transluminal drainage. From early experience, however, release of the proximal flange of the stent has mostly been done using endoscopic view guidance to ensure proper positioning. Aim We describe a new technique that we have named the Intra-Channel Stent Release Technique (ICSRT) to...
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#2Todd H. Baron (UNC: University of North Carolina at Chapel Hill)H-Index: 116
ABSTRACTIntroduction: Endoscopic ultrasound guided translumenal drainage of pancreatic fluid collections (PFCs) has been widely practiced for over a decade, using conventional plastic and self-expandable metal stents. The use of such stents for transmural drainage is off-label and limited by the lack of lumen-to-lumen anchorage, which can lead to leakage, migration and tissue trauma.Areas covered: Novel stent designs dedicated to applications of translumenal drainage have recently emerged and pr...
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Cited By61
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#2Susumu HijiokaH-Index: 27
Source
EUS-guided choledochoduodenostomy (EUS-CDS) is an effective option for biliary drainage in malignant biliary obstruction. Lumen apposing metal stents (LAMS) are increasingly been used for EUS-CDS. It is unknown how LAMS compare to tubular self-expandable metal stents (SEMS) for EUS-CDS. Our aim is to compare the clinical outcomes of LAMS versus SEMS for EUS-CDS. Single-center retrospective cohort study of consecutive patients with unresectable malignant biliary obstruction who underwent EUS-CDS ...
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Background null EUS-guided biliary drainage (EUS-BD) with Lumen Apposing Metal Stent (LAMS) is a mini-invasive approach for jaundice palliation in distal malignant biliary obstruction (D-MBO) not amenable to ERCP, with good efficacy and not exiguous adverse events. null Aims and methods null From January 2015 to December 2019, we retrospectively enrolled all the EUS-BD with electrocautery-enhanced LAMS for biliary decompression in unresectable D-MBO and failed ERCP. Primary study aims were to ev...
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#1Mihai Rimbas (UMFCD: Carol Davila University of Medicine and Pharmacy)H-Index: 9
#2Andrea AnderloniH-Index: 29
Last. Gianenrico Rizzatti (CUA: The Catholic University of America)H-Index: 12
view all 37 authors...
Background and study aims Feasibility of EUS-guided choledochoduodenostomy (EUS-CDS) using available lumen-apposing stents (LAMS) is limited by the size of the common bile duct (CBD) (≤ 12 mm, cut-off for experts; 15 mm, cut-off for non-experts). We aimed to assess the prevalence and predictive factors associated with CBD size ≥ 12 and 15 mm in naive patients with malignant distal biliary obstruction (MDBO). null null null null null Patients and methods This was a prospective cohort study involv...
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#3Gianmarco Marocchi (AUSL: Academy for Urban School Leadership)H-Index: 2
Over the last decades, contrast-enhanced harmonic endoscopic ultrasound (CH-EUS) has emerged as an important diagnostic tool for the diagnosis and differentiation of several gastrointestinal diseases. The key advantage of CH-EUS is that the influx and washout of contrast in the target lesion can be observed in real time, accurately depicting microvasculature. CH-EUS is established as an evidence-based technique complementary to B-mode EUS to differentiate solid appearing structures, to character...
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In cases of malignant distal biliary obstruction, ERCP is the preferred technique for bile duct drainage. In case of failure, the alternative techniques are percutaneous transhepatic biliary drainage (PTBD) and more recently endoscopic ultrasound-guided biliary drainage. A new type of stent called the electrocautery-enhanced lumen-apposing metal stent (EC-LAMS) has been developed to enable the performance of biliary-enteric anastomosis under EUS-guidance in a single step, without prior bile duct...
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#1Shyam Vedantam (UM: University of Miami)
#2Sunil Amin (UM: University of Miami)H-Index: 4
If endoscopic retrograde cholangiopancreatography (ERCP) fails in cases of biliary obstruction and jaundice, percutaneous drains have been traditionally the current second-line option. Endoscopic ultrasonography-guided biliary drainage (EUS-BD) with choledocoduodenostomy or hepaticogastrostomy is alternative modality that have shown equivalent or better technical and clinical success compared with percutaneous drainage. Similarly, EUS-guided gallbladder drainage has emerged as a therapeutic opti...
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#8PJ Belletrutti (Humanitas University)H-Index: 4
#9Alessandro FugazzaH-Index: 17
Last. Calogero Cammà (University of Palermo)H-Index: 77
view all 13 authors...
Background Endoscopic ultrasound (EUS)-guided biliary drainage is becoming an option for palliation of malignant biliary obstruction. Lumen-apposing metal stents (LAMS) are replacing self-expandable metal stents (SEMS). The aim of this meta-analysis was to evaluate the efficacy and safety of LAMS and SEMS for EUS-guided choledochoduodenostomy (EUS-CDS). Methods A meta-analysis was performed using PRISMA protocols. Electronic databases were searched for studies on EUS-CDS. The primary outcome was...
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