EUS-Guided Choledochoduodenostomy for Distal Malignant Biliary Obstruction Using Electrocautery-Enhanced Lumen-Apposing Metal Stents: First US, Multicenter Experience

Chafic, Abdul Hamid El; Shah, Janak N.; Hamerski, Chris M.; Binmoeller, Kenneth F.; Irani, Shayan; James, Theodore W.; Baron, Todd H.; Nieto, José; Romero, Ricardo V.; Evans, John A.; Kahaleh, Michel

doi:10.1007/s10620-019-05688-2

Cited by 71 publications

(82 citation statements)

References 21 publications

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“…Similarly, El Chafic et al retrospectively reviewed the outcomes and clinical success in 67 patients from six different US centers treated with EUS-CD using ECE-LAMS. The overall outcomes were extremely high (technical and clinical efficacy 96 % and 100 %, respectively) with an average rate of AEs (8 % early and 18 % delayed AEs) [21].…”

Section: Discussionmentioning

confidence: 97%

Endoscopic ultrasound-guided biliary drainage of malignant stenosis, not treatable with endoscopic retrograde cholangiopancreatography: a single-center, prospective observational study

et al. 2021

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Background and study aims The therapeutic role of endoscopic ultrasound (EUS) evolved in recent decade,s opening a new chapter in the field of endoscopic biliary drainage (BD). EUS-BD has emerged as a new mini-invasive technique for neoplastic jaundice not amenable to endoscopic retrograde cholangiopancreatography (ERCP). The primary study aims were to assess the clinical efficacy of EUS-BD using an electrocautery-enhanced lumen apposing metal stent (ECE-LAMS) in patients with malignant biliary obstruction with failed\unfeasible ERCP and the adverse event (AE) rate. The secondary aims were to evaluate the technical success and incidence of jaundice recurrence. Patients and methods Data from All patients referred to our tertiary-care Institute with obstructive jaundice due to unresectable malignant distal biliary stricture and unfeasible\failed ERCP, were prospectively recorded from January 2015 to February 2018. The procedures were performed by a single-step ECE-LAMS (AXIOS-EC, Boston Scientific) placement, from the upper gut lumen to the biliary tree, for definitive biliary decompression. Results Twenty-one patients were consecutively enrolled. Mean pre-procedure common bile duct diameter was 16 mm and the bilirubin level was 13.9 mg/dL (range 3.8–29.5). LAMS was positioned from the duodenal bulb (n = 19) to gastric antrum (n = 2). We registered a 100 % of technical and clinical success. No AEs occurred. We observed a single case of delayed AE consisting of a buried LAMS, which was successfully resolved endoscopically. Conclusions Despite the limits of being non-comparative, our study shows outcomes in a homogeneous population in terms of indications and technique. EUS-BD with dedicated ECE-LAMS is associated with extremely good clinical efficacy and safety and can be considered as an alternative in cases of failed/unfeasible ERCP.

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Section: Discussionmentioning

confidence: 97%

Endoscopic ultrasound-guided biliary drainage of malignant stenosis, not treatable with endoscopic retrograde cholangiopancreatography: a single-center, prospective observational study

et al. 2021

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“…Most stent occlusions occurred in the early period of the study (< 30 days). One US multicenter, retrospective analysis of EUS-CDS using ECE-LAMS demonstrated a significant reduction in rates of stent occlusion (50 % to 11.8 %) with preemptive placement of an axis-orienting stent through the LAMS 24 . This highlights the notion that LAMS can occlude early, and therefore, lends credit to prophylactic placement of axis-orienting stents through the LAMS lumen to prevent stent occlusion.…”

Section: Discussionmentioning

confidence: 99%

Safety and outcomes of endoscopic ultrasound-guided drainage for malignant biliary obstruction using cautery-enabled lumen-apposing metal stent

2020

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Background and study aims There is increasing evidence to suggest that EUS-guided biliary drainage (EUS-BD) is a safe and effective treatment alternative for patients with malignant biliary obstructions (MBOs) after failed endoscopic retrograde cholangiopancreatography. Patients and methods We performed a retrospective analysis of data prospectively collected from patients with MBO who underwent choledochoduodenostomy (CDS) or gallbladder drainage (GBD) between August 2016 and June 2020 using the electrocautery-enabled lumen-apposing metal stents (ECE-LAMS). The primary endpoint was technical and clinical success. Secondary endpoints were adverse events (AEs) and reinterventions. Results A total of 60 patients were included in the study, with 56 CDS and 4 GBD. Median age was 76 years with 57 % male (34/60). The most common indication for EUS-BD was pancreatic cancer (78 %). Technical success was achieved in 100 % of cases, with a clinical success rate of 91.7 %. Mean total bilirubin pre-procedure was 202 umol/L (normal < 20 umol/L) and 63.8 umol/L post procedure (P < .001). Twenty-one patients had bilirubin recorded at 2 weeks post EUS-BD with 20 of 21 patients demonstrating > 50 % reduction in bilirubin (mean bilirubin reduction 75 %). AEs occurred in 12 of 60 patients (20 %), all of which were mild. The reintervention rate was 11.7 % (7/60). Stent occlusion occurred in 10 of 60 patients (16.7 %) with a mean time to stent occlusion of 46.2 days (3–133). Stent patency of 83.3 % was observed with a mean follow up of 7.9 months. Conclusion EUS-CDS and GBD using ECE-LAMS are effective EUS-based techniques for managing patients with MBO. AEs are usually mild and resolved by reintervention.

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“…ERCP is the election treatment of malignant biliary obstruction which has a percentage of technical failure in those cases in which the neoplastic invasion of the papilla does not allow cannulation and therefore biliary drainage, which leads to the need to proceed with procedures such PTBD that infers a higher percentage of morbidity [ 1 , 2 , 9 ].…”

Section: Discussionmentioning

confidence: 99%

“…During the last decade the development of endoscopic ultrasound (EUS) has implied an alternative for biliary drainage in cases of failed ERCP, demonstrating advantages over PTBD, such as the possibility of performing in the same intervention when the derivation is not achieved by ERCP and also less pain and infection [ 2 , 8 ].…”

Section: Discussionmentioning

confidence: 99%

“…The clinical success of endoscopic ultrasound guided biliary drainage with choledocoduodenostomy has been exposed in multiple series with the use of different stents and devices, to the point of being proposed as the first-line option [ 2 ]; initially it was developed the USE-CD with plastic stents getting a clinical success demonstrated in several studies such as Hara et al who developed 94% and 100% technical and clinical success respectively, but with a percentage of stent occlusion at 163 days of 66.7% [ 6 ]. On the other hand, the risk of biliary leakage and cholangitis implies a significant percentage of morbidity which led to the use of metal stents for the use of USE-CD [ 6 ], so that studies such as Gupta and collaborators that compare the incidence of cholangitis in patients treated with plastic stents and patients treated with metal stents reporting a much higher incidence in the group treated with plastic stents, with a similar incidence of biliary leakage [ 6 ], but over time it is established As the most feared complication when using coated metal stents, the migration of the puncture site stent leaves an important defect open [ 6 ].…”

Section: Discussionmentioning

confidence: 99%

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Endoscopic ultrasound (EUS) guided choledocoduodenostomy in a patient with irresecable pancreas cancer and biliar obstruction using a luminal apposing metal stent (LAMS)

Pinto-Carta

Solano

Cabrera

et al. 2020

International Journal of Surgery Case Reports

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EUS-Guided Choledochoduodenostomy for Distal Malignant Biliary Obstruction Using Electrocautery-Enhanced Lumen-Apposing Metal Stents: First US, Multicenter Experience

Cited by 71 publications

References 21 publications

Endoscopic ultrasound-guided biliary drainage of malignant stenosis, not treatable with endoscopic retrograde cholangiopancreatography: a single-center, prospective observational study

Endoscopic ultrasound-guided biliary drainage of malignant stenosis, not treatable with endoscopic retrograde cholangiopancreatography: a single-center, prospective observational study

Safety and outcomes of endoscopic ultrasound-guided drainage for malignant biliary obstruction using cautery-enabled lumen-apposing metal stent

Endoscopic ultrasound (EUS) guided choledocoduodenostomy in a patient with irresecable pancreas cancer and biliar obstruction using a luminal apposing metal stent (LAMS)

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