Is a coaxial plastic stent within a lumen-apposing metal stent useful for the management of distal malignant biliary obstruction?

Published on Mar 15, 2021in Surgical Endoscopy and Other Interventional Techniques4.584
· DOI :10.1007/S00464-021-08435-9
Albert Garcia-Sumalla2
Estimated H-index: 2
(University of Barcelona),
C Loras1
Estimated H-index: 1
(Open University of Catalonia)
+ 7 AuthorsJoan B. Gornals15
Estimated H-index: 15
(University of Barcelona)
Sources
Abstract
BACKGROUND There are uncertainties concerning the possible benefits derived from the insertion of double-pigtail plastic stents (DPS) within lumen-apposing metal stents (LAMS) in EUS-guided choledochoduodenostomy (CDS). The aim of this study was to determine whether a DPS within a biliary LAMS offers a potential benefit in EUS-guided CDS for the palliative management of malignant biliary obstruction. METHODS This was a multicentre retrospective study at three tertiary institutions. PERIOD May 2015 to August 2020. Two interventional strategies (LAMS alone and LAMS plus DPS) were compared. The choice was the endoscopist's discretion. Inclusion: unresectable/inoperable biliopancreatic tumours with previous failed ERCP. Clinical success: bilirubin decrease > 30% at 4 weeks. RESULTS Forty-one consecutive cases of EUS-CDS using biliary LAMS were treated (22 women; mean age, 72.3 years) during the study period. The procedure was technically successful in 39 (95.1%), who were managed using the two strategies (22 LAMS alone; 17 LAMS plus DPS). No differences between the groups, in terms of clinical success (77.3 vs 87.5%, p = 0.67), adverse events (AEs, 13.6 vs 11.8%, p = 0.99), recurrent biliary obstruction (RBO, 13.6 vs 23.5%, p = 0.67), or survival rate (p = 0.67) were encountered. The LAMS alone group had a shorter length of procedure (50 min vs 66 min, p = 0.102). No risk factors related to clinical success, AEs, RBO, or survival were detected. CONCLUSIONS The technical variant of adding a coaxial DPS within LAMS in EUS-CDS seems not to be enough to prevent biliary morbidities, and it is a time-consuming strategy. Although prospective studies are needed, these results do not support its routine use.
References25
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#2Jocelyn PrivatH-Index: 6
Last. Bertrand NapoleonH-Index: 31
view all 13 authors...
Background and Aims EUS guided biliary drainage is indicated in case of impossibility or failure of classic biliary drainage by ERCP. Recently we reported a good efficiency of EUS-guided choledocoduodenostomy (EUS-CDS) using the ECE-LAMS (electrocautery-enhanced lumen-apposing metal stent) in a retrospective multicentric study. Utilization of the recommended technique (direct punction with the ECE-LAMS using a pure cut current + using a 6 mm stent) was the only predicting factor of clinical succ...
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#1Rajesh Krishnamoorthi (Virginia Mason Medical Center)H-Index: 16
#2Chandra S. Dasari (Veterans Health Administration)H-Index: 6
Last. Shayan Irani (Virginia Mason Medical Center)H-Index: 29
view all 10 authors...
Endoscopic ultrasound-guided choledochoduodenostomy (CDD) is emerging as an alternative technique for biliary drainage in patients who fail conventional endoscopic retrograde cholangiopancreatography (ERCP). The lumen-apposing metal stents (LAMS) are being increasingly used for CDD. We performed a systematic review and meta-analysis to evaluate the effectiveness and safety of CDD using LAMS. We performed a systematic search of multiple databases through May 2019 to identify studies on CDD using ...
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#1Yen I. Chen (MUHC: McGill University Health Centre)H-Index: 1
#2Kashi Callichurn (UdeM: Université de Montréal)H-Index: 1
Last. Rastislav Kunda (Vrije Universiteit Brussel)H-Index: 2
view all 27 authors...
Endoscopic ultrasound guided-biliary drainage (EUS-BD) is a promising alternative to endoscopic retrograde cholangiopancreatography (ERCP); however, its growth has been limited by a lack of multicenter randomized controlled trials (RCT) and dedicated devices. A dedicated EUS-BD lumen- apposing metal stent (LAMS) has recently been developed with the potential to greatly facilitate the technique and safety of the procedure. We aim to compare a first intent approach with EUS-guided choledochoduoden...
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BACKGROUND AND STUDY AIMS: the use of endoscopic ultrasound-guided biliary drainage (EUS-BD) has increased in cases of failed endoscopic retrograde cholangiopancreatography (ERCP) and there are some concerns. The main aim of the study was to determine the role of EUS-BD in a palliative case cohort. The secondary aim was to compare the efficacy, safety and survival of EUS-BD and ERCP procedures. PATIENTS AND METHODS: this was an observational study at a single tertiary institution, with a consecu...
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#1Abdul Hamid El Chafic (Ochsner Medical Center)H-Index: 10
#2Janak N. Shah (Ochsner Medical Center)H-Index: 22
Last. Michel Kahaleh (Cornell University)H-Index: 72
view all 11 authors...
Background and Aims EUS-guided biliary drainage has emerged as a technique to enable endobiliary drainage in failed ERCP. A newer model, lumen-apposing metal stents (LAMS), with a cautery-enhanced delivery system became available in the USA in late 2015. This cautery-tipped version may facilitate EUS-guided choledochoduodenostomy (EUS-CD), but data using this model are lacking.
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#1Babu P. Mohan (UA: University of Alabama)H-Index: 14
Last. Douglas G. Adler (UofU: University of Utah)H-Index: 69
view all 6 authors...
Introduction:Endoscopic retrograde cholangiopancreatography is the preferred method in biliary drainage. Endoscopic ultrasound (EUS) guidance has shown tremendous success in situations where endoscopic retrograde cholangiopancreatography fails or is contraindicated. EUS-guided choledochoduodenostomy
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#1Simona AttardoH-Index: 3
#2Francesco AuriemmaH-Index: 8
Last. Alessandro Repici (Humanitas University)H-Index: 75
view all 7 authors...
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#1Carlo Fabbri (AUSL: Academy for Urban School Leadership)H-Index: 23
#2Alessandro FugazzaH-Index: 17
Last. Andrea AnderloniH-Index: 29
view all 8 authors...
We present five cases of pylorus-preserving pancreaticoduodenectomy (PPPD) after endoscopic ultrasonography-guided choledochoduodenostomy (EUS-CD) using a lumen-apposing metal stent (LAMS) as a bridge to surgery in patients with resectable distal malignant biliary obstruction and failed endoscopic retrograde cholangiopancreatography (ERCP). The patients underwent an EUS-CD using EC-LAMS, the bile duct being accessed using the transbulbar approach. The technical success rate of EUS-CD was 100%. N...
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#1Andrea AnderloniH-Index: 29
#2Alessandro FugazzaH-Index: 17
Last. Alessandro Repici (Humanitas University)H-Index: 75
view all 11 authors...
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...
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#1Tsuyoshi Hamada (UTokyo: University of Tokyo)H-Index: 43
#2Yousuke Nakai (UTokyo: University of Tokyo)H-Index: 53
Last. Hiroyuki Isayama (Juntendo University)H-Index: 67
view all 3 authors...
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Cited By0
Newest
#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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