EUS-guided choledochoduodenostomy with electrocautery-enhanced lumen-apposing metal stents in patients with malignant distal biliary obstruction: multicenter collaboration from the United Kingdom and Ireland

On, Wei; Paranandi, Bharat; Smith, Andrew M.; Venkatachalapathy, Suresh; James, Martin; Aithal, Guruprasad P.; Varbobitis, Ioannis; Cheriyan, Danny; McDonald, Ciaran; Leeds, John S.; Nayar, Manu; Oppong, Kofi; Geraghty, Joe; Devlin, John; Ahmed, Wafaa; Scott, Ryan; Wong, Terence; Huggett, Matthew T.

doi:10.1016/j.gie.2021.09.040

Cited by 29 publications

(33 citation statements)

References 24 publications

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“…EC-LAMS is currently a well-established technique for drainage of jaundice caused by MBO, with technical and clinical success rates of more than 90 % with an acceptable AE rate [12]. Placement of an EC-LAMS was primarily reserved only for patients in whom conventional ERCP was unsuccessful [13] or for patients in whom endoscopic drainage by ERCP was not feasible because of surgically altered anatomy [14].…”

Section: Discussionmentioning

confidence: 99%

EUS-guided biliary drainage with a novel electrocautery-enhanced lumen apposing metal stent as first approach for distal malignant biliary obstruction: a prospective study

et al. 2022

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Background and study aims Endoscopic retrograde cholangiopancreatography (ERCP) represents the gold standard for jaundice palliation in malignant biliary obstruction (MBO) patients. Biliary drainage using electrocautery lumen apposing metal stent (EC-LAMS) is currently a well-established procedure when ERCP fails. We aimed to assess the technical and clinical success of a new EC-LAMS as the first approach to the palliation of malignant jaundice due to MBO in patients unfit for surgery. Patients and methods Twenty-five consecutive patients undergoing endoscopic-guided biliary drainage with the new EC-LAMS were prospectively enrolled. Clinical success was defined as bilirubin level decrease > 15 % 24 hours after EC-LAMS placement. Results Mean age was 76.6 ± 11.56 years, and male patients were 10 (40 %). EC-LAMS placement was technically feasible in 24 patients (96 %) and clinical success rate was 100 %. Only one patient (4 %) experienced a misplacement rescued by an immediate second EC-LAMS placement. The mean duration of hospital stay was 4.66 ± 4.22 days. The median overall survival was 7 months (95 % CI 1–7). Conclusions In this preliminary study, the new EC-LAMS seems to allow a single-step palliative endoscopic therapy in patients affected by jaundice due to MBO, with high technical and clinical success and low adverse events. Further large prospective studies are warranted to validate these results.

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Section: Discussionmentioning

confidence: 99%

EUS-guided biliary drainage with a novel electrocautery-enhanced lumen apposing metal stent as first approach for distal malignant biliary obstruction: a prospective study

et al. 2022

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“…In a U.S. multicentre retrospective study, El Cha c et al proposed this technical variant, because RBO developed in signi cantly more patients with LAMS alone compared to LAMS plus DPS (50% vs. 11.8%; p=0.02) [23]. Similarly, two recent papers, including a large cohort from the UK and Ireland, revealed lower rates of cholangitis and BRI (0% vs 12.2%, p .03) in the DPS-LAMS group [22,27]. None of these previous studies were speci cally designed for comparing the usefulness of the coaxial stent.…”

Section: Discussionmentioning

confidence: 99%

Multicenter Study of Lumen-apposing Metal Stents With or Without Pigtail in Endoscopic Ultrasound-guided Biliary Drainage for Malignant Obstruction- Bampi Trial: an Open-label, Randomized Controlled Trial Protocol.

García-Sumalla

Loras

Sánchiz

et al. 2022

Preprint

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Background: It is unclear whether the insertion of an axis-orienting double-pigtail plastic stent (DPS) through biliary lumen-apposing meal stent (LAMS) in EUS-guided choledochoduodenostomy (CDS) improves the stent patency. The aim of this study is to determine whether this technical variant offers a clinical benefit in EUS-guided biliary drainage (BD) for the management of distal malignant biliary obstruction.Methods/design: This is a multicenter open-label, randomized controlled trial with two parallel groups. Eighty-four patients with malignant biliary obstruction will undergo EUS-BD (CDS type) using LAMS in 7 tertiary hospitals in Spain and will be randomized to the LAMS and LAMS plus DPS groups. The primary endpoint is the rate of recurrent biliary obstruction, as a stent dysfunction parameter, detected during follow-up. Secondary endpoints: technical and clinical success (reduction in bilirubin >50% within 14 days of stent placement), safety, and others (number of reinterventions, time to biliary obstruction, prognostic factors, survival rate).Discussion: The BAMPI trial has been designed to determine whether the addition of a coaxial axis-orienting DPS through LAMS is superior to LAMS alone to prevent stent dysfunction. Trial registration: ClinicalTrials.gov, NCT04595058. Registered on October 14, 2020.

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“…Recent studies have increasingly been using LAMS, which may be attributing to lower rates of stent malfunction. A large multicenter cohort in the United Kingdom and Ireland found that the technical success, clinical success, adverse events and reintervention rates using LAMS were 90.8%, 94.8%, 17.5%, and 8.3%, respectively[ 72 ]. Initially, plastic stents were used when EUS-CDS was first introduced.…”

Section: Endoscopic Ultrasound Guided Biliary Drainagementioning

confidence: 99%

Endoscopic palliation of malignant biliary obstruction

Canakis¹,

Kahaleh²

2022

World J Gastrointest Endosc

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Malignant biliary obstruction often presents with challenges requiring the endoscopist to assess the location of the lesion, the staging of the disease, the eventual resectability and patient preferences in term of biliary decompression. This review will focus on the different modalities available in order to offer the most appropriate palliation, such as conventional endoscopic retrograde cholangiopancreatography, endoscopic ultrasound guided biliary drainage as well as ablative therapies including photodynamic therapy or radiofrequency ablation.

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EUS-guided choledochoduodenostomy with electrocautery-enhanced lumen-apposing metal stents in patients with malignant distal biliary obstruction: multicenter collaboration from the United Kingdom and Ireland

Cited by 29 publications

References 24 publications

EUS-guided biliary drainage with a novel electrocautery-enhanced lumen apposing metal stent as first approach for distal malignant biliary obstruction: a prospective study

EUS-guided biliary drainage with a novel electrocautery-enhanced lumen apposing metal stent as first approach for distal malignant biliary obstruction: a prospective study

Multicenter Study of Lumen-apposing Metal Stents With or Without Pigtail in Endoscopic Ultrasound-guided Biliary Drainage for Malignant Obstruction- Bampi Trial: an Open-label, Randomized Controlled Trial Protocol.

Endoscopic palliation of malignant biliary obstruction

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