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

Abstract

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.

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

“…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 .…”

Technical tips and recent development of endoscopic ultrasound‐guided choledochoduodenostomy

“…Table 1 shows recent studies regarding EUS‐CDS (published in the last 5 years [between 2015 and 2020], and including over 15 cases). 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 The main indication is failed ERCP, but recent studies have tried to evaluate the clinical efficacy of EUS‐CDS for primary drainage. 8 , 13 , 19 , 20 , 26 Technical success rates of EUS‐CDS range from 88.8% to 100%, and the clinical success rate ranges from 85.5% to 100%.…”

A Novel Lumen-Apposing Metal Stent with an Electrocautery Tip for Different Indications: Initial Experience in a Referral Center

“…The use of LAMS has shown to decrease recovery time, costs, and duration of hospital stay, compared to previous treatments [ 2 ]. There are several main indications for LAMS placement, such as for the treatment of pancreatic pseudocyst, walled-off pancreatic necrosis (WOPN), malignant biliary obstruction, cholecystitis and gastric outlet obstruction (GOO) [ 3 , 4 , 5 , 6 ]. LAMS can be also placed through the meshes of an indwelled duodenal self-expandable metal stent, during the same procedure [ 7 , 8 ].…”