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

García-Sumalla, Albert; Loras, Carme; Guarner-Argente, Carlos; Velasquez-Rodriguez, Julio G.; Andújar, Xavier; Salord, Silvia; Busquets, Juli; Tebé, Cristian; Laquente, Berta; Gornals, Joan B.

doi:10.1007/s00464-021-08435-9

Cited by 33 publications

(35 citation statements)

References 24 publications

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“…Available data from retrospective studies, randomized controlled trials (RCTs), and meta-analyses have reported comparable technical and clinical success rates for EUS-CDS and EUS-HGS ( Tables 1 s and 2 s , see online-only Supplementary material) 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 . Pooled data from studies directly comparing these two techniques in 303 and 329 patients respectively, estimated technical and clinical success rates of 94 % and 88 % for EUS-CDS, and 96 % and 87 % for EUS-HGS ( Table 3 s ) 10 18 19 30 38 39 40 41 42 43 44 45 46 .…”

Section: Biliary and Pancreatic Duct Drainagementioning

confidence: 95%

Therapeutic endoscopic ultrasound: European Society of Gastrointestinal Endoscopy (ESGE) Guideline

et al. 2021

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Main Recommendations 1 ESGE recommends the use of endoscopic ultrasound-guided biliary drainage (EUS-BD) over percutaneous transhepatic biliary drainage (PTBD) after failed endoscopic retrograde cholangiopancreatography (ERCP) in malignant distal biliary obstruction when local expertise is available.Strong recommendation, moderate quality evidence. 2 ESGE suggests EUS-BD with hepaticogastrostomy only for malignant inoperable hilar biliary obstruction with a dilated left hepatic duct when inadequately drained by ERCP and/or PTBD in high volume expert centers.Weak recommendation, moderate quality evidence. 3 ESGE recommends that EUS-guided pancreatic duct (PD) drainage should only be considered in symptomatic patients with an obstructed PD when retrograde endoscopic intervention fails or is not possible.Strong recommendation, low quality evidence. 4 ESGE recommends rendezvous EUS techniques over transmural PD drainage in patients with favorable anatomy owing to its lower rate of adverse events.Strong recommendation, low quality evidence. 5 ESGE recommends that, in patients at high surgical risk, EUS-guided gallbladder drainage (GBD) should be favored over percutaneous gallbladder drainage where both techniques are available, owing to the lower rates of adverse events and need for re-interventions in EUS-GBD.Strong recommendation, high quality of evidence. 6 ESGE recommends EUS-guided gastroenterostomy (EUS-GE), in an expert setting, for malignant gastric outlet obstruction, as an alternative to enteral stenting or surgery.Strong recommendation, low quality evidence. 7 ESGE recommends that EUS-GE may be considered in the management of afferent loop syndrome, especially in the setting of malignancy or in poor surgical candidates. Strong recommendation, low quality evidence. 8 ESGE suggests that endoscopic ultrasound-directed transgastric ERCP (EDGE) can be offered, in expert centers, to patients with a Roux-en-Y gastric bypass following multidisciplinary decision-making, with the aim of overcoming the invasiveness of laparoscopy-assisted ERCP and the limitations of enteroscopy-assisted ERCP.Weak recommendation, low quality evidence.

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Section: Biliary and Pancreatic Duct Drainagementioning

confidence: 95%

Therapeutic endoscopic ultrasound: European Society of Gastrointestinal Endoscopy (ESGE) Guideline

et al. 2021

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“…Double-pigtail plastic stents (DPPSs) may be placed through the metal stent to maintain stent patency [60,61]. Prophylactic DPPS placement through a LAMS was however not found to improve any procedural outcome in a multicenter retrospective cohort study [64].…”

Section: Stent Maldeployment and Perforationmentioning

confidence: 99%

Therapeutic endoscopic ultrasound: European Society of Gastrointestinal Endoscopy (ESGE) Technical Review

et al. 2022

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Main Recommendations 1 ESGE recommends a prolonged course of a prophylactic broad-spectrum antibiotic in patients with ascites who are undergoing therapeutic endoscopic ultrasound (EUS) procedures.Strong recommendation, low quality evidence. 2 ESGE recommends placement of partially or fully covered self-expandable metal stents during EUS-guided hepaticogastrostomy for biliary drainage in malignant disease.Strong recommendation, moderate quality evidence. 3 ESGE recommends EUS-guided pancreatic duct (PD) drainage should only be performed in high volume expert centers, owing to the complexity of this technique and the high risk of adverse events.Strong recommendation, low quality evidence. 4 ESGE recommends a stepwise approach to EUS-guided PD drainage in patients with favorable anatomy, starting with rendezvous-assisted endoscopic retrograde pancreatography (RV-ERP), followed by antegrade or transmural drainage only when RV-ERP fails or is not feasible.Strong recommendation, low quality evidence. 5 ESGE suggests performing transduodenal EUS-guided gallbladder drainage with a lumen-apposing metal stent (LAMS), rather than using the transgastric route, as this may reduce the risk of stent dysfunction.Weak recommendation, low quality evidence. 6 ESGE recommends using saline instillation for small-bowel distension during EUS-guided gastroenterostomy.Strong recommendation, low quality evidence. 7 ESGE recommends the use of saline instillation with a 19G needle and an electrocautery-enhanced LAMS for EUS-directed transgastric endoscopic retrograde cholangiopancreatography (EDGE) procedures.Strong recommendation, low quality evidence. 8 ESGE recommends the use of either 15- or 20-mm LAMSs for EDGE, with a preference for 20-mm LAMSs when considering a same-session ERCP.Strong recommendation, low quality evidence.

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“…The DPS plus LAMS group had a higher clinical success rate, non-signi cantly lower AE rate, and longer signi cant procedural time. Curiously, the RBO rate was a little bit higher in the DPS-LAMS group [19]. Therefore, these results did not support this technical variant being used routinely, and it was a time-consuming approach.…”

Section: Discussionmentioning

confidence: 82%

“…The insertion of a coaxial double-pigtail plastic stent (DPS) has been demonstrated to improve LAMS patency and bile ow, by maintaining a vertical orientation in the bile duct. But a recent retrospective study by our group did not encounter su cient evidence to recommend its routine use [19].…”

Section: Introductionmentioning

confidence: 89%

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

Cited by 33 publications

References 24 publications

Therapeutic endoscopic ultrasound: European Society of Gastrointestinal Endoscopy (ESGE) Guideline

Therapeutic endoscopic ultrasound: European Society of Gastrointestinal Endoscopy (ESGE) Guideline

Therapeutic endoscopic ultrasound: European Society of Gastrointestinal Endoscopy (ESGE) Technical Review

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.

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