Endoscopic ultrasound-guided choledochoduodenostomy with electrocautery-enhanced lumen-apposing stents: a retrospective analysis.

Published on Jun 1, 2019in Endoscopy10.093
· DOI :10.1055/A-0735-9137
Jérémie Jacques15
Estimated H-index: 15
,
Jocelyn Privat6
Estimated H-index: 6
+ 9 AuthorsBertrand Napoleon31
Estimated H-index: 31
Sources
Abstract
Background Endoscopic ultrasound-guided biliary drainage is an alternative to percutaneous biliary drainage in cases of malignant biliary obstruction and failure of classic endoscopic drainage by endoscopic retrograde cholangiopancreatography (ERCP). Recently, a new electrocautery-enhanced lumen-apposing metal stent (ECE-LAMS) that allows for endoscopic anastomosis (apposition stent) has become available for use in EUS-choledochoduodenostomy (EUS-CDS) and facilitates the procedure. Methods This was a retrospective study of all EUS-CDS procedures performed in France between April 2016 and August 2017. The primary end point was the technical and clinical success rates of EUS-CDS using an ECE-LAMS. Results 52 consecutive patients were included in the study. The etiology of distal bile duct obstruction was distal pancreatic adenocarcinoma in 43 patients (82.7 %). The technical success rate was 88.5 % (46 /52 patients), and the clinical success rate was 100 % (46/46 patients). The mean duration of the procedure was 10.2 minutes (range 1 – 90). Two patients (3.8 %) presented with short-term complications after EUS-CDS and before discharge from hospital. In univariate analyses, a small diameter of the common bile duct and not following the recommended procedure technique were significant risk factors for technical failure. Over a mean follow-up of 157 days, the median survival time without biliary complications was 135 days. Conclusion EUS-CDS with an ECE-LAMS is efficacious and safe in distal malignant obstruction of the common bile duct and could be proposed as the first option in cases of ERCP failure.
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References12
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#1Joo Kyung Park (SMC: Samsung Medical Center)H-Index: 23
#2Young Sik Woo (Sacred Heart Hospital)H-Index: 5
Last. Kwang Hyuck Lee (SKKU: Sungkyunkwan University)H-Index: 33
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Background and Aims ERCP-guided biliary drainage (ERCP-BD) is a criterion standard treatment for malignant biliary obstruction when curative surgery is not an option. Alternative methods such as percutaneous transhepatic biliary drainage would significantly lower the quality of life. EUS-guided biliary drainage (EUS-BD) has been developed and performed by experienced endoscopists. Therefore, the aims of this study were to evaluate the efficacy and safety of EUS-BD compared with ERCP in malignant...
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Aim:The goal of the study is to compare the efficacy and safety of bile duct drains guided by endoscopic ultrasound-guided biliary drainage (EGBD) versus percutaneous transhepatic biliary drainage (PTBD).Materials and Methods:Retrospective comparative study. Patients with obstruction of the bile duc
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#2Muhammad Ali Khan (UTHSC: University of Tennessee Health Science Center)H-Index: 22
BACKGROUND AND AIMS: Endoscopic ultrasound-guided biliary drainage (EUS-BD) has emerged as an alternative in cases of endoscopic retrograde cholangiopancreatography (ERCP) failure. Two types of EUS-BD methods for achieving biliary drainage when ERCP fails are choledochoduodenostomy (CDS) or hepaticogastrostomy (HGS). However, there is no consensus if one approach is better than the other. Therefore, we conducted a systematic review and meta-analysis to evaluate these 2 main EUS-BD methods. METHO...
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#1Mihai Rimbas (UMFCD: Carol Davila University of Medicine and Pharmacy)H-Index: 9
#2Alberto Larghi (CUA: The Catholic University of America)H-Index: 32
: When endoscopic retrograde cholangiopancreatography (ERCP) fails to decompress the biliary system or the pancreatic duct, endoscopic ultrasonography (EUS)-guided biliary or pancreatic access and drainage can be used. Data show a high success rate and acceptable adverse event rate for EUS-guided biliary drainage. The outcomes of EUS-guided biliary drainage seem equivalent to percutaneous drainage and ERCP, whereas only retrospective studies are available for pancreatic duct drainage. In this ar...
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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
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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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#1Adrien Sportes (Paris V: Paris Descartes University)H-Index: 3
#2Marine Camus (Paris V: Paris Descartes University)H-Index: 19
Last. Frederic PratH-Index: 38
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Background:Percutaneous transhepatic biliary drainage (PTBD) is widely performed as a salvage procedure in patients with unresectable malignant obstruction of the common bile duct (CBD) after faile...
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#1Amy Tyberg (Cornell University)H-Index: 22
#2Amit P. Desai (Cornell University)H-Index: 16
Last. Michel Kahaleh (Cornell University)H-Index: 72
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Background and Aims EUS-guided biliary drainage (EUS-BD) has been offered for more than a decade as an alternative to percutaneous biliary drainage. Multiple approaches have been described. We propose an algorithm for biliary drainage based on patient anatomy. We aim to assess its validity and safety to guide EUS-BD drainage. Methods All patients with biliary obstruction who underwent EUS-BD after failed ERCP from July 2011 through November 2015 underwent the drainage procedure according to the ...
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#1Rastislav Kunda (Aarhus University Hospital)H-Index: 20
Last. Alberto Larghi (CUA: The Catholic University of America)H-Index: 32
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Background A novel lumen-apposing, self-expanding metal stent to perform EUS-guided drainage procedures has been recently developed. The aim of this study was to analyze the safety, technical and clinical effectiveness of this device for EUS-guided choledochoduodenostomy (EUS-CD) with palliative intent.
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Background and Aims Variable success and adverse event rates have been reported for endoscopic ultrasound-guided biliary drainage (EUS-BD) utilizing either extrahepatic or intrahepatic approach. We aimed to conduct a proportion meta-analysis to evaluate the cumulative efficacy and safety of EUS-BD and to compare the two approaches and transluminal methods of EUS-BD.
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Cited By35
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#2Susumu HijiokaH-Index: 27
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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
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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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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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#8PJ Belletrutti (Humanitas University)H-Index: 4
#9Alessandro FugazzaH-Index: 17
Last. Calogero Cammà (University of Palermo)H-Index: 77
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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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#1Hae Won Yoo (SCH: Soonchunhyang University)H-Index: 1
#2Jong Ho Moon (SCH: Soonchunhyang University)H-Index: 40
Last. Don Haeng Lee (Inha University)H-Index: 33
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BACKGROUND The use of a lumen-apposing metal stent (LAMS) capable of one-step endoscopic ultrasound-guided transmural drainage (EUS-TD) can increase the effectiveness of the procedure. We evaluated the newly developed electrocautery-enhanced (EC) delivery system with a LAMS for one-step EUS-guided gallbladder drainage (EUS-GBD) or choledochoduodenostomy (EUS-CDS). METHODS In the animal experiment, an EC-LAMS was advanced into the gallbladder without prior tract dilation in four pigs. A conventio...
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#1Suresh Vasan Venkatachalapathy (NUH: Nottingham University Hospitals NHS Trust)H-Index: 3
#2Martin W. James (NUH: Nottingham University Hospitals NHS Trust)H-Index: 14
Last. Guruprasad P. Aithal (University of Nottingham)H-Index: 63
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BACKGROUND AND AIMS Biliary drainage with ERCP is successful in only 80% to 90% of extrahepatic cholangiocarcinoma and pancreatic cancer. We present the results of a multicenter prospective study assessing the safety, feasibility, and quality of life of patients after EUS-guided biliary drainage (EUS-BD) with lumen-apposing metal stents (LAMSs), after failed ERCP. METHODS All consecutive adults with a dilated common bile duct (CBD) ≥14 mm secondary to inoperable malignant distal common bile duct...
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#2Thomas LambinH-Index: 4
Last. Mathieu PiocheH-Index: 19
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