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Fritzsche JA, Fockens P, Besselink MG, Busch OR, Daams F, Wielenga MCB, Wilmink JW, Voermans RP, Van Wanrooij RLJ. Optimizing EUS-guided choledochoduodenostomy with lumen-apposing metal stents for primary drainage of malignant distal biliary obstruction (SCORPION-IIp): a prospective pilot study. Gastrointest Endosc 2025; 101:1009-1016. [PMID: 39424003 DOI: 10.1016/j.gie.2024.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Revised: 06/27/2024] [Accepted: 10/10/2024] [Indexed: 10/21/2024]
Abstract
BACKGROUND AND AIMS Biliary drainage by ERCP in patients with malignant distal bile duct obstruction (MBO) is frequently associated with adverse events, such as pancreatitis, hampering patient outcomes. EUS-guided choledochoduodenostomy (EUS-CDS) with a lumen-apposing metal stent (LAMS) is a promising alternative in patients with MBO but is associated with a worrisome risk of stent dysfunction. Placement of a fully covered self-expandable metal stent (FCSEMS) through the LAMS, thereby changing the axis of biliary drainage toward the descending duodenum, may decrease the risk of stent dysfunction while maintaining high technical success and low adverse event rates. METHODS This was a prospective single-center pilot study in patients with pathology-confirmed MBO without gastric outlet obstruction. The primary outcome was stent dysfunction, defined as recurrent jaundice after initial clinical success, ongoing jaundice in combination with persistent bile duct dilatation, or cholangitis. RESULTS Overall, 27 consecutive patients eligible for EUS-CDS were enrolled. The placement of a LAMS was successful in 24 of 27 patients (89%), and placement of a FCSEMS through the LAMS was successful in 20 of 24 (83%); in the remaining 4 patients, a coaxial double-pigtail plastic stent was placed. Two of these 20 patients experienced persistent jaundice requiring stent revision (10%), leading to a clinical success rate of 90%. No patients developed stent dysfunction after initial clinical success. CONCLUSIONS This study showed a stent dysfunction rate of 10% after technically successful EUS-CDS with placement of a FCSEMS through the LAMS. Improving the design of LAMSs may further reduce the rate of stent dysfunction. (Clinical trial registration number: NCT05595122.).
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Affiliation(s)
- Jeska A Fritzsche
- Department of Gastroenterology and Hepatology, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands; Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, The Netherlands; Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Paul Fockens
- Department of Gastroenterology and Hepatology, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands; Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, The Netherlands; Cancer Center Amsterdam, Amsterdam, The Netherlands; Department of Gastroenterology and Hepatology, Amsterdam UMC, location Vrije Universiteit, Amsterdam, The Netherlands
| | - Marc G Besselink
- Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, The Netherlands; Cancer Center Amsterdam, Amsterdam, The Netherlands; Department of Surgery, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands
| | - Olivier R Busch
- Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, The Netherlands; Cancer Center Amsterdam, Amsterdam, The Netherlands; Department of Surgery, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands
| | - Freek Daams
- Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, The Netherlands; Cancer Center Amsterdam, Amsterdam, The Netherlands; Department of Surgery, Amsterdam UMC, location Vrije Universiteit, Amsterdam, The Netherlands
| | - Mattheus C B Wielenga
- Department of Gastroenterology and Hepatology, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands; Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, The Netherlands; Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Johanna W Wilmink
- Cancer Center Amsterdam, Amsterdam, The Netherlands; Department of Medical Oncology, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands
| | - Rogier P Voermans
- Department of Gastroenterology and Hepatology, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands; Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, The Netherlands; Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Roy L J Van Wanrooij
- Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, The Netherlands; Cancer Center Amsterdam, Amsterdam, The Netherlands; Department of Gastroenterology and Hepatology, Amsterdam UMC, location Vrije Universiteit, Amsterdam, The Netherlands
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Chen YI, Long C, Sahai AV, Napoleon B, Donatelli G, Kunda R, Martel M, Chan SM, Arcidiacono PG, Lam E, Kongkam P, Forbes N, Larghi A, Mosko JD, Van der Merwe S, Gan SI, Jacques J, Kenshil S, Ratanachu-Ek T, Miller C, Saxena P, Desilets E, Sandha G, Alrifae Y, Teoh AYB. Stent misdeployment and factors associated with failure in endoscopic ultrasound-guided choledochoduodenostomy: analysis of the combined datasets from two randomized trials. Endoscopy 2025; 57:330-338. [PMID: 39505002 DOI: 10.1055/a-2463-1601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2024]
Abstract
BACKGROUND Stent misdeployment (SMD) is a feared and poorly characterized technical challenge of endoscopic ultrasound (EUS)-guided choledochoduodenostomy (CDS) using lumen-apposing stents. We aimed to ascertain the rate of stent misdeployment in EUS-CDS for malignant distal biliary obstruction (MDBO) and describe its outcomes while identifying variables associated with its occurrence. METHOD This was a post hoc analysis of two randomized controlled trials comparing EUS-CDS vs. endoscopic retrograde cholangiopancreatography in MDBO. The primary end point was rate of SMD, classified as misdeployment of the distal flange (type I), proximal flange (type II), contralateral bile duct wall injury (type III), or double mucosal puncture (type IV). Multivariable analysis was performed to identify variables associated with SMD and/or technical failure, and with clinical failure or stent dysfunction. RESULTS 152 patients were included. Technical success was 93.4 %. SMD occurred in 11 patients (7.2 %; 95 %CI 3.1 %-11.4 %): 8 type I, 1 type II, and 2 type III. Endoscopic salvage of SMD was successful in 81.8 %. Misdeployment led to adverse events in four patients (two mild, two moderate), giving an overall SMD-related adverse event rate of 2.6 % (95 %CI 0.7 %-6.6 %). On multivariable analysis, extrahepatic bile duct diameter of ≤ 15 mm was associated with increased odds of SMD and/or technical failure. CONCLUSION SMD was relatively common in EUS-CDS and was associated with an extrahepatic bile duct diameter of ≤ 15 mm. The majority of misdeployments could be rescued endoscopically with low risk for adverse events.
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Affiliation(s)
- Yen-I Chen
- Division of Gastroenterology and Hepatology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Clara Long
- Division of Gastroenterology and Hepatology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Anand V Sahai
- Service de Gastroentérologie, Centre Hospitalier de l'Université de Montréal, Montréal, Quebec, Canada
| | | | - Gianfranco Donatelli
- Unité d'Endoscopie Interventionnelle, Hôpital Privé des Peupliers, Paris, France
| | - Rastislav Kunda
- Department of Surgery, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
- Department of Gastroenterology-Hepatology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
- Department of Advanced Interventional Endoscopy, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
- Department of Surgical Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
| | - Myriam Martel
- Division of Gastroenterology and Hepatology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Shannon M Chan
- Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Paolo G Arcidiacono
- Pancreato-Biliary Endoscopy and Endosonography Division, Pancreas Translational and Clinical Research Center, San Raffaele Scientific Institute IRCCS, Vita Salute San Raffaele University, Milan, Italy
| | - Eric Lam
- Division of Gastroenterology and Hepatology, St-Paul Hospital, Vancouver, British Columbia, Canada
| | - Pradermchai Kongkam
- Division of Hospital and Ambulatory Medicine and Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Nauzer Forbes
- Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Alberta, Canada
| | - Alberto Larghi
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Jeffrey D Mosko
- Division of Gastroenterology, St-Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Schalk Van der Merwe
- Department of Gastroenterology and Hepatology, The University of Leuven, Leuven, Belgium
| | - Seng Ian Gan
- Division of Gastroenterology and Hepatology, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Jeremie Jacques
- Gastroenterology Department, Dupuytren University Hospital, Limoges, France
| | - Sana Kenshil
- Division of Gastroenterology and Hepatology, Ottawa Hospital, Ottawa, Ontario, Canada
| | | | - Corey Miller
- Division of Gastroenterology and Hepatology, Jewish General Hospital, Montreal, Quebec, Canada
| | - Payal Saxena
- Department of Gastroenterology, Royal Prince Alfred Hospital, Sidney, Australia
| | - Etienne Desilets
- Division of Gastroenterology, Hôpital Charles-Le Moyne, Longeuil, Quebec, Canada
| | - Gurpal Sandha
- Division of Gastroenterology and Hepatology, University of Alberta Hospital, Edmonton, Alberta, Canada
| | - Yousef Alrifae
- Division of Gastroenterology and Hepatology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Anthony Y B Teoh
- Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
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Ramai D, Dawod E, Darwin PE, Kim RE, Kim JH, Wang J, Lanka C, Bakain T, Mahadev S, Sampath K, Carr-Locke DL, Morris JD, Sharaiha RZ. Endoscopic Ultrasound-guided Transmural Biliary Drainage With 6 mm and 8 mm Cautery-enhanced Lumen-apposing Metal Stents: A Multicenter Collaborative Study. J Clin Gastroenterol 2025; 59:376-383. [PMID: 39042493 DOI: 10.1097/mcg.0000000000002043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Accepted: 06/03/2024] [Indexed: 07/25/2024]
Abstract
OBJECTIVE Endoscopic retrograde cholangiopancreatography (ERCP) may be unsuccessful in patients with duodenal stenosis or malignant ampullary infiltration. Endoscopic ultrasound-guided biliary drainage (EUS-BD) has been proposed as an alternative. We aimed to assess the efficacy and safety of EUS-BD for malignant distal bile duct obstruction using the newly introduced smaller caliber 6 or 8 mm cautery-enhanced lumen-apposing metal stent. METHODS A multicenter retrospective study was performed on patients with unresectable malignant distal bile duct obstruction who underwent EUS-BD between 2021 and 2022 after unsuccessful ERCP. RESULTS Thirty-two patients were included [7 (53.13%) males], with a mean age of 72.2 ± 12.5 years. The technical success rate was 100%. Altered anatomy was present in 2 (6.25%). The indication for drainage was biliary obstruction from pancreatic cancer in 26 patients (84.5%), cholangiocarcinoma in 3 (9.4%), and ampullary mass in 3 (9.4%). The procedure was performed mostly in an outpatient setting (n = 19, 59.38%). The clinical success rate was 92.3% [bilirubin: 14.1 (SD: 8.9) preprocedure vs 4.9 (SD: 1.1) postprocedure; P = 0.0001]. There was one early adverse event of a perforation, which was closed endoscopically and drained percutaneously. Delayed adverse events included food impaction of the stent (n = 1), which was resolved with a repeat procedure and insertion of a double pigtail stent. CONCLUSION This study demonstrates the feasibility of EUS-BD drainage using smaller caliber 6 or 8 mm lumen-apposing metal stent to relieve malignant distal bile duct obstruction in patients who fail conventional ERCP.
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Affiliation(s)
- Daryl Ramai
- Division of Gastroenterology and Hepatology, University of Utah Health, Salt Lake City, UT
| | - Enad Dawod
- Division of Gastroenterology and Hepatology, Weill Cornell Medical College/New York Presbyterian, New York City, NY
| | - Peter E Darwin
- Division of Gastroenterology and Hepatology, University of Maryland Medical Center, Baltimore, MD
| | - Raymond E Kim
- Division of Gastroenterology and Hepatology, University of Maryland Medical Center, Baltimore, MD
| | - Jeong Hoon Kim
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Jade Wang
- Division of Medicine, Weill Cornell Medical College/New York Presbyterian, New York City
| | - Chandana Lanka
- Department of Medicine, Mount Sinai South Nassau, Oceanside, NY
| | - Tarek Bakain
- Department of Medicine, Medstar Washington Hospital Center, Washington, DC
| | - SriHari Mahadev
- Division of Gastroenterology and Hepatology, Weill Cornell Medical College/New York Presbyterian, New York City, NY
| | - Kartik Sampath
- Division of Gastroenterology and Hepatology, Weill Cornell Medical College/New York Presbyterian, New York City, NY
| | - David L Carr-Locke
- Division of Gastroenterology and Hepatology, Weill Cornell Medical College/New York Presbyterian, New York City, NY
| | - John D Morris
- Division of Gastroenterology and Hepatology, University of Utah Health, Salt Lake City, UT
| | - Reem Z Sharaiha
- Division of Gastroenterology and Hepatology, Weill Cornell Medical College/New York Presbyterian, New York City, NY
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Ibnawadh S, Alfadda A, Ibnawadh A. A meta-analysis of the effectiveness and safety of endoscopic ultrasound-guided choledochoduodenostomy employing electrocautery-enhanced lumen-apposing metal stents for biliary drainage after failed endoscopic retrograde cholangiopancreatography. DEN OPEN 2025; 5:e70105. [PMID: 40276149 PMCID: PMC12018532 DOI: 10.1002/deo2.70105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/03/2024] [Revised: 03/09/2025] [Accepted: 03/16/2025] [Indexed: 04/26/2025]
Abstract
Objectives Endoscopic ultrasound-biliary drainage and choledochoduodenostomy (EUS-CDD) are increasingly being used as alternative procedures for biliary drainage in patients in whom endoscopic retrograde cholangiopancreatography fails. Novel electrocautery-enhanced lumen-apposing metal stents (EC-LAMS) are expected to be widely used for EUS-CDD. We performed a systematic review and meta-analysis to evaluate the technical and clinical success of EUS-CDD using EC-LAMS. Methods We performed a comprehensive search of several databases from inception to May 2022 to search for relevant studies on the effectiveness and safety of endoscopic ultrasound-guided biliary drainage using EC-LAMS. The pooled rates of technical success, clinical success, and early and late adverse events were calculated. Results Ten studies with a total of 481 patients were included in this analysis. The overall technical success rate was 94.3%, 95% confidence interval [CI] (91.5%-96.2%), The overall clinical success rate was 94.9%, 95% CI (92%-96.7%). The overall early adverse event rate was 5.1%, 95% CI (3.4%-7.8%), and the overall late adverse event rate was 10.8%, 95% CI (6.6%-17.2%). Conclusion In patients with biliary obstruction with failed endoscopic retrograde cholangiopancreatography, EUS-CDD using EC-LAMS is a good alternate management option with a high success rate and relatively low adverse events.
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Affiliation(s)
- Safiya Ibnawadh
- Department of MedicineSection of GastroenterologyKing Faisal Specialist Hospital and Research CenterRiyadhSaudi Arabia
| | - Abdulrahman Alfadda
- Department of MedicineSection of GastroenterologyKing Faisal Specialist Hospital and Research CenterRiyadhSaudi Arabia
| | - Abdulrahman Ibnawadh
- Department of MedicineKing Faisal Specialist Hospital and Research CenterRiyadhSaudi Arabia
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Tyberg A, Binmoeller K, Kowalski T. Lumen-apposing metal stents in 2024: troubleshooting and managing common and uncommon adverse events. Gastrointest Endosc 2025; 101:315-330. [PMID: 39369965 DOI: 10.1016/j.gie.2024.09.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2024] [Revised: 08/21/2024] [Accepted: 09/25/2024] [Indexed: 10/08/2024]
Affiliation(s)
- Amy Tyberg
- Hackensack Meridian Health, Hackensack University Hospital, New York, New York, USA
| | | | - Thomas Kowalski
- Pancreaticobiliary & Advanced Endoscopy Section, Sidney Kimmel College of Medicine, Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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Marzioni M, Crinò SF, Lisotti A, Fuccio L, Vanella G, Amato A, Bertani H, Binda C, Coluccio C, Forti E, Fugazza A, Ligresti D, Maida M, Marchegiani G, Mauro A, Mirante VG, Ricci C, Rizzo GEM, Scimeca D, Spadaccini M, Arvanitakis M, Anderloni A, Fabbri C, Tarantino I, Arcidiacono PG. Biliary drainage in patients with malignant distal biliary obstruction: results of an Italian consensus conference. Surg Endosc 2024; 38:6207-6226. [PMID: 39317905 PMCID: PMC11525304 DOI: 10.1007/s00464-024-11245-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2024] [Accepted: 08/30/2024] [Indexed: 09/26/2024]
Abstract
BACKGROUND Malignant Distal Biliary Obstruction (MBDO) is a common event occurring along the natural history of both pancreatic cancer and cholangiocarcinoma. Epidemiological and biological features make MBDO one of the key elements of the clinical management of patients suffering for of pancreatic cancer or cholangiocarcinoma. The development of dedicated biliary lumen-apposing metal stents (LAMS) is changing the clinical work up of patients with MBDO. i-EUS is an Italian network of clinicians and scientists with a special interest in biliopancreatic endoscopy, EUS in particular. METHODS The scientific methodology was chosen in line with international guidance and in a fashion similar to those applied by broader scientific associations. PICO questions were elaborated and subsequently voted by a broad panel of experts within a simplified Delphi process. RESULTS AND CONCLUSIONS The manuscripts describes the results of a consensus conference organized by i-EUS with the aim of providing an evidence based-guidance for the appropriate use of the techniques in patients with MBDO.
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Affiliation(s)
- Marco Marzioni
- Clinic of Gastroenterology and Hepatology, Università Politecnica delle Marche - Azienda Ospedaliero Universitaria delle Marche, Ancona, Italy.
| | - Stefano Francesco Crinò
- Diagnostic and Interventional Endoscopy of Pancreas, The Pancreas Institute, G.B. Rossi University Hospital, 37134, Verona, Italy
| | - Andrea Lisotti
- Gastroenterology Unit, Hospital of Imola, University of Bologna, Imola, Italy
| | - Lorenzo Fuccio
- Department of Medical and Surgical Sciences, University of Bologna - Gastroenterology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, S. Orsola Hospital, Bologna, Italy
| | - Giuseppe Vanella
- Pancreatobiliary Endoscopy and Endosonography Division, Pancreas Translational and Clinical Research Center, IRCCS San Raffaele Institute, Milan, Italy
| | - Arnaldo Amato
- Department of Digestive Endoscopy and Gastroenterology ASST, Lecco, Italy
| | - Helga Bertani
- Gastroenterologia ed Endoscopia Digestiva Azienda Ospedaliero-Universitaria Policlinico di Modena, Modena, Italy
| | - Cecilia Binda
- Gastroenterology and Digestive Endoscopy Unit, Forlì-Cesena Hospitals, AUSL Romagna, Forlì-Cesena, Italy
| | - Chiara Coluccio
- Gastroenterology and Digestive Endoscopy Unit, Forlì-Cesena Hospitals, AUSL Romagna, Forlì-Cesena, Italy
| | - Edoardo Forti
- Digestive and Interventional Endoscopy Unit, ASST Niguarda Hospital, Milan, Italy
| | - Alessandro Fugazza
- Division of Gastroenterology and Digestive Endoscopy, Humanitas Research Hospital - IRCCS, Rozzano, 20089, Milan, Italy
| | - Dario Ligresti
- Endoscopy Service, Department of Diagnostic and Therapeutic Services, IRCCS - ISMETT, Palermo, Italy
| | - Marcello Maida
- Gastroenterology Unit, Umberto I Hospital - Department of Medicine and Surgery, University of Enna 'Kore', Enna, Italy
| | - Giovanni Marchegiani
- Department of Surgical Oncological and Gastroenterological Sciences, Padua University Hospital, Padua, Italy
| | - Aurelio Mauro
- Gastroenterology and Digestive Endoscopy Unit, IRCCS Foundation Policlinico San Matteo, Viale Camillo Golgi 19, 27100, Pavia, Italy
| | - Vincenzo Giorgio Mirante
- Gastroenterologia ed Endoscopia Digestiva, Dipartimento Oncologico e Tecnologie Avanzate, AUSL IRCCS Reggio Emilia, Reggio Emilia, Italy
| | - Claudio Ricci
- Department of Medical and Surgical Sciences, University of Bologna - Division of Pancreatic Surgery, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | | | - Daniela Scimeca
- Gastroenterology and Endoscopy Unit, ARNAS Civico - Di Cristina - Benfratelli Hospital, 90127, Palermo, Italy
| | - Marco Spadaccini
- Division of Gastroenterology and Digestive Endoscopy, Humanitas Research Hospital - IRCCS, Rozzano, 20089, Milan, Italy
| | - Marianna Arvanitakis
- Clinic of Gastroenterology and Hepatology, Università Politecnica delle Marche - Azienda Ospedaliero Universitaria delle Marche, Ancona, Italy
- Diagnostic and Interventional Endoscopy of Pancreas, The Pancreas Institute, G.B. Rossi University Hospital, 37134, Verona, Italy
- Gastroenterology Unit, Hospital of Imola, University of Bologna, Imola, Italy
- Department of Medical and Surgical Sciences, University of Bologna - Gastroenterology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, S. Orsola Hospital, Bologna, Italy
- Pancreatobiliary Endoscopy and Endosonography Division, Pancreas Translational and Clinical Research Center, IRCCS San Raffaele Institute, Milan, Italy
- Department of Digestive Endoscopy and Gastroenterology ASST, Lecco, Italy
- Gastroenterologia ed Endoscopia Digestiva Azienda Ospedaliero-Universitaria Policlinico di Modena, Modena, Italy
- Gastroenterology and Digestive Endoscopy Unit, Forlì-Cesena Hospitals, AUSL Romagna, Forlì-Cesena, Italy
- Digestive and Interventional Endoscopy Unit, ASST Niguarda Hospital, Milan, Italy
- Division of Gastroenterology and Digestive Endoscopy, Humanitas Research Hospital - IRCCS, Rozzano, 20089, Milan, Italy
- Endoscopy Service, Department of Diagnostic and Therapeutic Services, IRCCS - ISMETT, Palermo, Italy
- Gastroenterology Unit, Umberto I Hospital - Department of Medicine and Surgery, University of Enna 'Kore', Enna, Italy
- Department of Surgical Oncological and Gastroenterological Sciences, Padua University Hospital, Padua, Italy
- Gastroenterology and Digestive Endoscopy Unit, IRCCS Foundation Policlinico San Matteo, Viale Camillo Golgi 19, 27100, Pavia, Italy
- Gastroenterologia ed Endoscopia Digestiva, Dipartimento Oncologico e Tecnologie Avanzate, AUSL IRCCS Reggio Emilia, Reggio Emilia, Italy
- Department of Medical and Surgical Sciences, University of Bologna - Division of Pancreatic Surgery, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
- Gastroenterology and Endoscopy Unit, ARNAS Civico - Di Cristina - Benfratelli Hospital, 90127, Palermo, Italy
| | - Andrea Anderloni
- Gastroenterology and Digestive Endoscopy Unit, IRCCS Foundation Policlinico San Matteo, Viale Camillo Golgi 19, 27100, Pavia, Italy
| | - Carlo Fabbri
- Gastroenterology and Digestive Endoscopy Unit, Forlì-Cesena Hospitals, AUSL Romagna, Forlì-Cesena, Italy
| | - Ilaria Tarantino
- Endoscopy Service, Department of Diagnostic and Therapeutic Services, IRCCS - ISMETT, Palermo, Italy
| | - Paolo Giorgio Arcidiacono
- Pancreatobiliary Endoscopy and Endosonography Division, Pancreas Translational and Clinical Research Center, IRCCS San Raffaele Institute, Milan, Italy
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Li JS, Tang J, Fang J, Li ZS, Liu F. Adverse events in endoscopic ultrasound-guided choledochoduodenostomy with lumen-apposing metal stents: A systematic review and meta-analysis. J Gastroenterol Hepatol 2024; 39:1769-1779. [PMID: 38736198 DOI: 10.1111/jgh.16614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 02/01/2024] [Accepted: 05/01/2024] [Indexed: 05/14/2024]
Abstract
BACKGROUND AND AIM Several meta-analyses have analyzed the technical and clinical success of endoscopic ultrasound-guided choledochoduodenostomy (EUS-CDS) by using lumen-apposing metal stents (LAMS) in malignant biliary obstruction, but those concerning adverse events (AEs) are scarce. The current systematic review and meta-analysis was conducted to evaluate the AEs after EUS-CDS with LAMS. METHODS A comprehensive literature search of PubMed, Embase, Scopus, Web of Science, and the Cochrane Library was conducted for studies reporting the outcomes of EUS-CDS with LAMS. The main endpoints were the incidence of overall and specific AEs. Moreover, the stent dysfunction, and reintervention rates were evaluated independently. RESULTS A total of 21 studies (n = 1438) were included in the final meta-analysis. The pooled rate of technical and clinical success was 93.5% (95% confidence interval [CI]: 91.3-95.1) and 88.0% (95% CI: 83.9-91.1), respectively. After EUS-CDS with LAMS, the pooled incidence of overall AEs was 20.1% (95% CI: 16.0-24.9). The estimated rate of early AEs was 10.6% (95% CI: 7.9-14.2), and late AEs was 11.2% (95% CI: 8.2-15.2). Infection/cholangitis was the commonest AE, with a pooled incidence of 6.1% (95% CI: 3.7-10.1). The estimated incidence of stent dysfunction and reintervention was 10.5% (95% CI: 7.5-14.4), and 12.1% (95% CI: 9.3-15.7), respectively. CONCLUSION Despite with a high technical and clinical success rate, EUS-CDS with LAMS may be associated with overall AEs and stent dysfunction in one-fifth and one-tenth of cases, respectively. Further efforts are required to optimize its safety and long-term stent patency.
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Affiliation(s)
- Jia-Su Li
- Department of Gastroenterology, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Jian Tang
- Digestive Endoscopy Center, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Jun Fang
- Department of Gastroenterology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Zhao-Shen Li
- Department of Gastroenterology, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Feng Liu
- Digestive Endoscopy Center, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
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Fiedler A, Dhindsa B, Bhat I, Singh S. Using the Rendezvous Technique Through Choledochoduodenostomy for Malignant Biliary Obstruction. ACG Case Rep J 2024; 11:e01370. [PMID: 38841704 PMCID: PMC11152879 DOI: 10.14309/crj.0000000000001370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Accepted: 04/22/2024] [Indexed: 06/07/2024] Open
Abstract
Endoscopic transpapillary biliary stenting via endoscopic retrograde cholangiopancreatography is the preferred therapy for benign and malignant distal biliary obstruction. In cases of failed endoscopic retrograde cholangiopancreatography, endoscopic ultrasound-guided choledochoduodenostomy has been shown to be as effective as percutaneous methods with an improved safety profile. Despite its efficacy, it is complicated by stent occlusion in 9%-26% of cases. To our knowledge, this is the first case in which biliary obstruction was relieved by performing a rendezvous procedure utilizing a pre-existing choledochoduodenostomy.
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Affiliation(s)
- Alexandra Fiedler
- Division of Internal Medicine, University of Nebraska Medical Center, Omaha, NE
| | - Banreet Dhindsa
- Division of Gastroenterology and Hepatology, NYU Langone Health, New York, NY
| | - Ishfaq Bhat
- Division of Gastroenterology and Hepatology, University of Nebraska Medical Center, Omaha, NE
| | - Shailender Singh
- Division of Gastroenterology and Hepatology, University of Nebraska Medical Center, Omaha, NE
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9
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Dietrich CF, Arcidiacono PG, Bhutani MS, Braden B, Burmester E, Fusaroli P, Hocke M, Ignee A, Jenssen C, Al-Lehibi A, Aljahdli E, Napoléon B, Rimbas M, Vanella G. Controversies in Endoscopic Ultrasound-Guided Biliary Drainage. Cancers (Basel) 2024; 16:1616. [PMID: 38730570 PMCID: PMC11083358 DOI: 10.3390/cancers16091616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 04/15/2024] [Accepted: 04/18/2024] [Indexed: 05/13/2024] Open
Abstract
In this 14th document in a series of papers entitled "Controversies in Endoscopic Ultrasound" we discuss various aspects of EUS-guided biliary drainage that are debated in the literature and in practice. Endoscopic retrograde cholangiography is still the reference technique for therapeutic biliary access, but EUS-guided techniques for biliary access and drainage have developed into safe and highly effective alternative options. However, EUS-guided biliary drainage techniques are technically demanding procedures for which few training models are currently available. Different access routes require modifications to the basic technique and specific instruments. In experienced hands, percutaneous transhepatic cholangiodrainage is also a good alternative. Therefore, in this paper, we compare arguments for different options of biliary drainage and different technical modifications.
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Affiliation(s)
- Christoph Frank Dietrich
- Department Allgemeine Innere Medizin der Kliniken (DAIM) Hirslanden Beau Site, Salem und Permanence, 3013 Bern, Switzerland
| | - Paolo Giorgio Arcidiacono
- Division of Pancreatobiliary Endoscopy and Endosonography, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, 20132 Milan, Italy; (P.G.A.); (G.V.)
| | - Manoop S. Bhutani
- Department of Gastroenterology Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA;
| | - Barbara Braden
- Medical Department B, University Münster, Albert-Schweitzer-Campus 1, 48149 Münster, Germany;
| | - Eike Burmester
- Medizinische Klinik I, Sana Kliniken Luebeck, 23560 Luebeck, Germany;
| | - Pietro Fusaroli
- Department of Medical and Surgical Sciences, Gastrointestinal Unit, University of Bologna/Hospital of Imola, 40126 Bologna, Italy
| | - Michael Hocke
- Medical Department II, Helios Klinikum Meiningen, 98617 Meiningen, Germany;
| | - Andrè Ignee
- Klinikum Würzburg Mitte, Standort Juliusspital, 97074 Würzburg, Germany;
| | - Christian Jenssen
- Medical Department, Krankenhaus Maerkisch-Oderland, 15441 Strausberg and Brandenburg Institute of Clinical Ultrasound at Medical University Brandenburg, 16816 Neuruppin, Germany;
| | - Abed Al-Lehibi
- Gastroenterology & Hepatology Department, King Fahad Medical City, Riyadh 11525, Saudi Arabia;
| | - Emad Aljahdli
- Faculty of Medicine, King Abdulaziz University, Gastrointestinal Oncology Unit, King Abdul-Aziz University Hospital (KAUH), Jeddah 22252, Saudi Arabia;
| | - Bertrand Napoléon
- Hopital Privé J Mermoz Ramsay Générale de Santé, 69008 Lyon, France;
| | - Mihai Rimbas
- Department of Gastroenterology, Clinic of Internal Medicine, Colentina Clinical Hospital, Carol Davila University of Medicine, 050474 Bucharest, Romania;
| | - Giuseppe Vanella
- Division of Pancreatobiliary Endoscopy and Endosonography, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, 20132 Milan, Italy; (P.G.A.); (G.V.)
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10
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Peng ZX, Chen FF, Tang W, Zeng X, Du HJ, Pi RX, Liu HM, Lu XX. Endoscopic-ultrasound-guided biliary drainage with placement of electrocautery-enhanced lumen-apposing metal stent for palliation of malignant biliary obstruction: Updated meta-analysis. World J Gastrointest Surg 2024; 16:907-920. [PMID: 38577086 PMCID: PMC10989328 DOI: 10.4240/wjgs.v16.i3.907] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 01/07/2024] [Accepted: 02/18/2024] [Indexed: 03/22/2024] Open
Abstract
BACKGROUND Endoscopic ultrasound-guided biliary drainage using electrocautery-enhanced (ECE) delivery of lumen-apposing metal stent (LAMS) is gradually being recognized as a viable palliative technique for malignant biliary obstruction after endoscopic retrograde cholangiopancreatography (ERCP) failure. However, most of the studies that have assessed its efficacy and safety were small and heterogeneous. Prior meta-analyses of six or fewer studies that were published 2 years ago were therefore underpowered to yield convincing evidence. AIM To update the efficacy and safety of ECE-LAMS for treatment of biliary obstruction after ERCP failure. METHODS We searched PubMed, EMBASE, and Scopus databases from the inception of the ECE technique to May 13, 2022. Primary outcome measure was pooled technical success rate, and secondary outcomes were pooled rates of clinical success, reintervention, and adverse events. Meta-analysis was performed using a random-effects model following Freeman-Tukey double-arcsine transformation in R software (version 4.1.3). RESULTS Fourteen eligible studies involving 620 participants were ultimately included. The pooled rate of technical success was 96.7%, and clinical success was 91.0%. Adverse events were reported in 17.5% of patients. Overall reintervention rate was 7.3%. Subgroup analyses showed results were generally consistent. CONCLUSION ECE-LAMS has favorable success with acceptable adverse events in relieving biliary obstruction when ERCP is impossible. The consistency of results across most subgroups suggested that this is a generalizable approach.
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Affiliation(s)
- Zu-Xiang Peng
- Department of Hepatobiliary Surgery, Daping Hospital, Army Medical University, Chongqing 400042, China
| | - Fang-Fang Chen
- Department of Oncology, Chongqing General Hospital, Chongqing University, Chongqing 401147, China
| | - Wen Tang
- Department of Hepatobiliary Surgery, Daping Hospital, Army Medical University, Chongqing 400042, China
| | - Xu Zeng
- Department of Gastroenterology and Hepatobiliary Surgery, People’s Hospital of Fenggang County, Guizhou 564200, Guizhou Province, China
| | - Hong-Juan Du
- Department of Oncology, Chongqing General Hospital, Chongqing University, Chongqing 401147, China
| | - Ru-Xian Pi
- Department of Hepatobiliary Surgery, Daping Hospital, Army Medical University, Chongqing 400042, China
| | - Hong-Ming Liu
- Department of Hepatobiliary Surgery, Daping Hospital, Army Medical University, Chongqing 400042, China
| | - Xiao-Xiao Lu
- Hepatobiliary and Pancreatic Tumor Center, Chongqing University Cancer Hospital, Chongqing 400030, China
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11
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Fabbri C, Scalvini D, Paolo G, Binda C, Mauro A, Coluccio C, Mazza S, Trebbi M, Torello Viera F, Anderloni A. Complications and management of interventional endoscopic ultrasound: A critical review. Best Pract Res Clin Gastroenterol 2024; 69:101888. [PMID: 38749575 DOI: 10.1016/j.bpg.2024.101888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Accepted: 01/30/2024] [Indexed: 07/13/2024]
Abstract
In the last decades, Endoscopic ultrasound (EUS) has rapidly grown and evolved from being mainly a diagnostic procedure, to being an interventional and therapeutic tool in several pathological clinical scenarios. With the progressive growth in technical expertise and dedicated devices, interventional endoscopic ultrasound procedures (IEUSP) have shown high rates of technical and clinical success, together with a relatively safe profile. However, the description and the standardization of different and specific types of adverse events (AEs) are still scarce in literature, and, consequently, even less the management of AEs. The aim of this study is to critical review and to describe AEs related to each of the main IEUSP, and to provide an overview on the possible management strategies of endoscopic complications. Future studies and guidelines are surely required to reach a better standardization of different AEs and their best management.
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Affiliation(s)
- Carlo Fabbri
- Gastroenterology and Digestive Endoscopy Unit, Forlì-Cesena Hospitals, AUSL Romagna, Forlì, Italy
| | - Davide Scalvini
- Gastroenterology and Digestive Endoscopy Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy
| | - Giuffrida Paolo
- Gastroenterology and Digestive Endoscopy Unit, Forlì-Cesena Hospitals, AUSL Romagna, Forlì, Italy.
| | - Cecilia Binda
- Gastroenterology and Digestive Endoscopy Unit, Forlì-Cesena Hospitals, AUSL Romagna, Forlì, Italy
| | - Aurelio Mauro
- Gastroenterology and Digestive Endoscopy Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Chiara Coluccio
- Gastroenterology and Digestive Endoscopy Unit, Forlì-Cesena Hospitals, AUSL Romagna, Forlì, Italy
| | - Stefano Mazza
- Gastroenterology and Digestive Endoscopy Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Margherita Trebbi
- Gastroenterology and Digestive Endoscopy Unit, Forlì-Cesena Hospitals, AUSL Romagna, Forlì, Italy
| | - Francesca Torello Viera
- Gastroenterology and Digestive Endoscopy Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Andrea Anderloni
- Gastroenterology and Digestive Endoscopy Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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12
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Fugazza A, Khalaf K, Spadaccini M, Facciorusso A, Colombo M, Andreozzi M, Carrara S, Binda C, Fabbri C, Anderloni A, Hassan C, Baron T, Repici A. Outcomes predictors in endoscopic ultrasound-guided choledochoduodenostomy with lumen-apposing metal stent: Systematic review and meta-analysis. Endosc Int Open 2024; 12:E456-E462. [PMID: 38550768 PMCID: PMC10978093 DOI: 10.1055/a-2271-2145] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 01/11/2024] [Indexed: 07/22/2024] Open
Abstract
Background and study aims EUS-guided choledochoduodenostomy (EUS-CDS) is a minimally invasive procedure used to treat malignant biliary obstruction (MBO) by transduodenal placement of a lumen-apposing metal stent (LAMS) into the extrahepatic bile duct. To identify factors that contribute to safe and effective EUS-CDS using LAMS, we performed a systematic review of the literature and meta-analysis. Methods The methodology of our analysis was based on PRISMA recommendations. Electronic databases (Medline, Scopus, EMBASE) were searched up to November 2022. Full articles that included patients with distal malignant biliary obstruction who underwent EUS-CDS using LAMS after failed endoscopic retrograde cholangiopancreatography were eligible. Random-effect meta-analysis was performed reporting pooled rates of technical success, clinical success, and adverse events (AEs) by means of a random model. Multivariate meta-regression and subgroup analysis were performed to assess possible associations between the outcomes and selected variables to assess the correlation between outcomes and different variables. Results were also stratified according to stent size. Results Twelve studies with 845 patients were included in the meta-analysis. Pooled technical and clinical success rates were 96% (95% confidence interval [CI] 94%-98%; I 2 = 52.29%) and 96% (95%CI 95%-98%), respectively, with no significant association with baseline characteristics, such are sex, age, common bile duct diameter, or stent size. The pooled AE rate was 12% (95%CI: 8%-16%; I 2 = 71.62%). The AE rate was significantly lower when using an 8 × 8 mm stent as compared with a 6 × 8 mm LAMS (odds ratio 0.59, 0.35-0.99; P = 0.04), with no evidence of heterogeneity (I 2 = 0%). Conclusions EUS-CDS with LAMS is a safe and effective option for relief of MBO. Selecting an appropriate stent size is crucial for achieving optimal safety outcomes.
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Affiliation(s)
- Alessandro Fugazza
- Division of Gastroenterology and Digestive Endoscopy, Department of Gastroenterology, IRCCS Humanitas Research Hospital, Rozzano (MI), Italy
| | - Kareem Khalaf
- Division of Gastroenterology, St Michael's Hospital, Toronto, Canada
| | - Marco Spadaccini
- Division of Gastroenterology and Digestive Endoscopy, Department of Gastroenterology, IRCCS Humanitas Research Hospital, Rozzano (MI), Italy
| | | | - Matteo Colombo
- Division of Gastroenterology and Digestive Endoscopy, Department of Gastroenterology, IRCCS Humanitas Research Hospital, Rozzano (MI), Italy
| | - Marta Andreozzi
- Division of Gastroenterology and Digestive Endoscopy, Department of Gastroenterology, IRCCS Humanitas Research Hospital, Rozzano (MI), Italy
| | - Silvia Carrara
- Division of Gastroenterology and Digestive Endoscopy, Department of Gastroenterology, IRCCS Humanitas Research Hospital, Rozzano (MI), Italy
| | - Cecilia Binda
- Gastroenterology and Digestive Endoscopy Unit, Forlì-Cesena Hospitals, Ausl Romagna, Forlì-Cesena, Italy
| | - Carlo Fabbri
- Gastroenterology and Digestive Endoscopy Unit, Forlì-Cesena Hospitals, Ausl Romagna, Forlì-Cesena, Italy
| | - Andrea Anderloni
- Gastroenterology and Digestive Endoscopy Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Cesare Hassan
- Division of Gastroenterology and Digestive Endoscopy, Department of Gastroenterology, IRCCS Humanitas Research Hospital, Rozzano (MI), Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Todd Baron
- Gastroenterology & Hepatology, University of North Carolina, Chapel Hill, United States
| | - Alessandro Repici
- Division of Gastroenterology and Digestive Endoscopy, Department of Gastroenterology, IRCCS Humanitas Research Hospital, Rozzano (MI), Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
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13
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Chen YI, Barkun A, Sahai A. Reply. Gastroenterology 2024; 166:539-540. [PMID: 38141857 DOI: 10.1053/j.gastro.2023.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 12/15/2023] [Indexed: 12/25/2023]
Affiliation(s)
- Yen-I Chen
- Division of Gastroenterology and Hepatology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Alan Barkun
- Division of Gastroenterology and Hepatology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Anand Sahai
- Service de Gastroentérologie, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
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14
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Li JS, Tang J, Liu F. Endoscopic Ultrasound-Guided Choledochoduodenostomy Using Lumen-Apposing Metal Stents vs Endoscopic Retrograde Cholangiopancreatography: Further Efforts Are Required. Gastroenterology 2024; 166:538-539. [PMID: 37604240 DOI: 10.1053/j.gastro.2023.08.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 08/15/2023] [Indexed: 08/23/2023]
Affiliation(s)
- Jia-Su Li
- Department of Gastroenterology, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Jian Tang
- Digestive Endoscopy Center, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Feng Liu
- Digestive Endoscopy Center, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
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15
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Guilmoteau T, Albouys J, Taibi A, Legros R, Schaefer M, Jacques J. Will Endoscopic-Ultrasound-Guided Choledocoduodenostomy with Electrocautery-Enhanced Lumen-Apposing Metal Stent Placement Replace Endoscopic Retrograde Cholangiopancreatography When Treating Distal Malignant Biliary Obstructions? MEDICINA (KAUNAS, LITHUANIA) 2024; 60:220. [PMID: 38399508 PMCID: PMC10889952 DOI: 10.3390/medicina60020220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Revised: 01/09/2024] [Accepted: 01/25/2024] [Indexed: 02/25/2024]
Abstract
Malignant distal biliary obstructions are becoming increasingly common, especially in patients with cancers of the pancreatic head, despite progress in medical oncology research. ERCP is the current gold standard for management of such strictures, but the emergence of EC-LAMS has rendered EUS-CDS both safe and efficient. It is a "game changer"; originally intended for ERCP failure, two randomised clinical trials recently proposed EUS-CDS as a first-intent procedure in palliative settings. For resectable diseases, the absence of iatrogenic pancreatitis associated with a lower rate of postsurgical adverse events (compared with ERCP) leads us to believe that EUS-CDS might be used in first-intent as a pre-operative endoscopic biliary drainage.
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Affiliation(s)
- Thomas Guilmoteau
- Hepatogastroenterology, Centre Hospitalier Universitaire Dupuytren, 87000 Limoges, France; (T.G.); (J.A.); (A.T.); (R.L.)
| | - Jérémie Albouys
- Hepatogastroenterology, Centre Hospitalier Universitaire Dupuytren, 87000 Limoges, France; (T.G.); (J.A.); (A.T.); (R.L.)
| | - Abdelkader Taibi
- Hepatogastroenterology, Centre Hospitalier Universitaire Dupuytren, 87000 Limoges, France; (T.G.); (J.A.); (A.T.); (R.L.)
| | - Romain Legros
- Hepatogastroenterology, Centre Hospitalier Universitaire Dupuytren, 87000 Limoges, France; (T.G.); (J.A.); (A.T.); (R.L.)
| | - Marion Schaefer
- Hepatogastroenterology, Nancy Regional University Hospital Center, 54500 Nancy, France;
| | - Jérémie Jacques
- Hepatogastroenterology, Centre Hospitalier Universitaire Dupuytren, 87000 Limoges, France; (T.G.); (J.A.); (A.T.); (R.L.)
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16
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Chavan R, Baraldo S, Rajput S. Inclusion of Patients With Duodenal Obstruction in Endoscopic Retrograde Cholangiopancreatography Group: Not a Right Intention. Gastroenterology 2024; 166:215. [PMID: 37192709 DOI: 10.1053/j.gastro.2023.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 05/11/2023] [Indexed: 05/18/2023]
Affiliation(s)
- Radhika Chavan
- Department of Gastroenterology and Advanced Endoscopy, Ansh Clinic, Gujarat, India
| | - Stefano Baraldo
- Department of Endoscopy, Barretos Cancer Hospital, Sao Paulo, Brazil
| | - Sanjay Rajput
- Department of Gastroenterology and Advanced Endoscopy, Ansh Clinic, Gujarat, India
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17
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Fritzsche JA, Fockens P, Besselink MG, Busch OR, Daams F, Montazeri NSM, Wilmink JW, Voermans RP, Van Wanrooij RLJ. Endoscopic ultrasound-guided choledochoduodenostomy using single-step lumen-apposing metal stents for primary drainage of malignant distal biliary obstruction (SCORPION-p): a prospective pilot study. Endoscopy 2024; 56:47-52. [PMID: 37473780 PMCID: PMC11321721 DOI: 10.1055/a-2134-3537] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 07/20/2023] [Indexed: 07/22/2023]
Abstract
BACKGROUND This study aimed to assess the safety and feasibility of endoscopic ultrasound-guided choledochoduodenostomy (EUS-CDS) using a lumen-apposing metal stent (LAMS) as a primary drainage strategy in patients with distal malignant biliary obstruction (MBO). METHODS A prospective, single-center, pilot study was conducted in patients with pathology-confirmed MBO without gastric outlet obstruction. The primary outcome was technical success. Secondary outcomes included clinical success, adverse events (AEs), and reinterventions. The study was registered in the Netherlands Trial Registry (registry number NL9757). RESULTS 22 patients were enrolled (median age 69.5 years [interquartile range 64-75.3]). Technical success was achieved in 20/22 patients (91 %). AEs occurred in one patient, namely perforation following inadequate stent deployment (5 %), which was treated in the same procedure. Clinical success was achieved in 19/22 patients (86 %). Stent dysfunction was observed in 11/20 patients (55 %) after technically successful EUS-CDS: two patients were treated conservatively and nine patients underwent reintervention(s). One patient died within ≤ 30 days due to fulminant disease progression. CONCLUSIONS The results confirmed the safety and feasibility of EUS-CDS using LAMS as a primary drainage strategy. The high incidence of stent dysfunction should be improved before EUS-CDS with LAMS can be seen as a valid alternative to endoscopic retrograde cholangiopancreatography.
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Affiliation(s)
- Jeska A. Fritzsche
- Department of Gastroenterology and Hepatology, Amsterdam UMC, location
University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Gastroenterology Endocrinology Metabolism, Research Institute,
Amsterdam, The Netherlands
- Treatment and Quality of life, Cancer Center Amsterdam, Amsterdam, The
Netherlands
| | - Paul Fockens
- Department of Gastroenterology and Hepatology, Amsterdam UMC, location
University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Gastroenterology Endocrinology Metabolism, Research Institute,
Amsterdam, The Netherlands
- Treatment and Quality of life, Cancer Center Amsterdam, Amsterdam, The
Netherlands
- Department of Gastroenterology and Hepatology, Amsterdam UMC, location Vrije
Universiteit, Amsterdam, The Netherlands
| | - Marc G. Besselink
- Amsterdam Gastroenterology Endocrinology Metabolism, Research Institute,
Amsterdam, The Netherlands
- Treatment and Quality of life, Cancer Center Amsterdam, Amsterdam, The
Netherlands
- Department of Surgery, Amsterdam UMC, location University of Amsterdam,
Amsterdam, The Netherlands
| | - Olivier R. Busch
- Amsterdam Gastroenterology Endocrinology Metabolism, Research Institute,
Amsterdam, The Netherlands
- Treatment and Quality of life, Cancer Center Amsterdam, Amsterdam, The
Netherlands
- Department of Surgery, Amsterdam UMC, location University of Amsterdam,
Amsterdam, The Netherlands
| | - Freek Daams
- Amsterdam Gastroenterology Endocrinology Metabolism, Research Institute,
Amsterdam, The Netherlands
- Treatment and Quality of life, Cancer Center Amsterdam, Amsterdam, The
Netherlands
- Department of Surgery, Amsterdam UMC, location Vrije Universiteit, Amsterdam,
The Netherlands
| | - Nahid S. M. Montazeri
- Amsterdam Gastroenterology Endocrinology Metabolism, Research Institute,
Amsterdam, The Netherlands
- Department of Gastroenterology and Hepatology, Biostatistics Unit, Amsterdam
UMC, location University of Amsterdam, Amsterdam, The Netherlands
| | - Johanna W. Wilmink
- Amsterdam Gastroenterology Endocrinology Metabolism, Research Institute,
Amsterdam, The Netherlands
- Treatment and Quality of life, Cancer Center Amsterdam, Amsterdam, The
Netherlands
- Department of Medical Oncology, Amsterdam UMC, location University of
Amsterdam, Amsterdam, The Netherlands
| | - Rogier P. Voermans
- Department of Gastroenterology and Hepatology, Amsterdam UMC, location
University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Gastroenterology Endocrinology Metabolism, Research Institute,
Amsterdam, The Netherlands
- Treatment and Quality of life, Cancer Center Amsterdam, Amsterdam, The
Netherlands
| | - Roy L. J. Van Wanrooij
- Amsterdam Gastroenterology Endocrinology Metabolism, Research Institute,
Amsterdam, The Netherlands
- Treatment and Quality of life, Cancer Center Amsterdam, Amsterdam, The
Netherlands
- Department of Gastroenterology and Hepatology, Amsterdam UMC, location Vrije
Universiteit, Amsterdam, The Netherlands
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18
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She YM, Ge N. Clinical application and follow-up of electrocautery-enhanced lumen-apposing metal stents for endoscopic ultrasonography-guided interventions. Ann Med 2023; 55:2282748. [PMID: 37967551 PMCID: PMC10653748 DOI: 10.1080/07853890.2023.2282748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 11/06/2023] [Indexed: 11/17/2023] Open
Abstract
Aim: The lumen-apposing metal stent (LAMS) is a new device that expands the scope of gastrointestinal intervention under endoscopy. LAMS was initially used for the treatment of pancreatic fluid collections (PFCs), but is increasingly being used off-label. The electrocautery system simplifies the deployment of LAMS, making it more suitable for off-label situations. The short-term results of electrocautery-enhanced lumen-apposing metal stents (ECE-LAMS) are satisfactory; however, the long-term follow-up results must be evaluated. The aim of this article is to review the expanded clinical application of ECE-LAMS, the clinical value of on-label and off-label use, and follow-up results.Methods: After searching in PubMed and Web of Science databases using 'electrocautery-enhanced lumen-apposing metal stents' and 'endoscopic ultrasonography (EUS) -guided interventions' as keywords, studies related were compiled and examined.Results: ECE-LAMS are widely used for on-label and off-label situations. The short-term and long-term results of ECE-LAMS are satisfactory, but there are still some studies that do not agree with this viewpoint.Conclusion: The clinical application of ECE-LAMS is relatively safe and reliable but more well-designed randomized trials and prospective studies are needed to evaluate the impact of this technology on therapeutic EUS, to improve the safety and success rate of EUS-guided LAMS implantation, and to expand its application in other indications.
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Affiliation(s)
- Yu Mo She
- Department of Gastroenterology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Nan Ge
- Department of Gastroenterology, Shengjing Hospital of China Medical University, Shenyang, China
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Giri S, Mohan BP, Jearth V, Kale A, Angadi S, Afzalpurkar S, Harindranath S, Sundaram S. Adverse events with EUS-guided biliary drainage: a systematic review and meta-analysis. Gastrointest Endosc 2023; 98:515-523.e18. [DOI: https:/doi.org/10.1016/j.gie.2023.06.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/13/2025]
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20
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Giri S, Mohan BP, Jearth V, Kale A, Angadi S, Afzalpurkar S, Harindranath S, Sundaram S. Adverse events with EUS-guided biliary drainage: a systematic review and meta-analysis. Gastrointest Endosc 2023; 98:515-523.e18. [PMID: 37392952 DOI: 10.1016/j.gie.2023.06.055] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 06/01/2023] [Accepted: 06/20/2023] [Indexed: 07/03/2023]
Abstract
BACKGROUND AND AIMS Multiple meta-analyses have evaluated the technical and clinical success of EUS-guided biliary drainage (BD), but meta-analyses concerning adverse events (AEs) are limited. The present meta-analysis analyzed AEs associated with various types of EUS-BD. METHODS A literature search of MEDLINE, Embase, and Scopus was conducted from 2005 to September 2022 for studies analyzing the outcome of EUS-BD. The primary outcomes were incidence of overall AEs, major AEs, procedure-related mortality, and reintervention. The event rates were pooled using a random-effects model. RESULTS One hundred fifty-five studies (7887 patients) were included in the final analysis. The pooled clinical success rates and incidence of AEs with EUS-BD were 95% (95% confidence interval [CI], 94.1-95.9) and 13.7% (95% CI, 12.3-15.0), respectively. Among early AEs, bile leak was the most common followed by cholangitis with pooled incidences of 2.2% (95% CI, 1.8-2.7) and 1.0% (95% CI, .8-1.3), respectively. The pooled incidences of major AEs and procedure-related mortality with EUS-BD were .6% (95% CI, .3-.9) and .1% (95% CI, .0-.4), respectively. The pooled incidences of delayed migration and stent occlusion were 1.7% (95% CI, 1.1-2.3) and 11.0% (95% CI, 9.3-12.8), respectively. The pooled event rate for reintervention (for stent migration or occlusion) after EUS-BD was 16.2% (95% CI, 14.0-18.3; I2 = 77.5%). CONCLUSIONS Despite a high clinical success rate, EUS-BD may be associated with AEs in one-seventh of the cases. However, major AEs and mortality incidence remain less than 1%, which is reassuring.
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Affiliation(s)
- Suprabhat Giri
- Department of Gastroenterology, Nizam's Institute of Medical Sciences, Hyderabad, India
| | - Babu P Mohan
- Department of Gastroenterology, University of Utah, Salt Lake City, Utah, USA
| | - Vaneet Jearth
- Department of Gastroenterology, Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Aditya Kale
- Department of Gastroenterology, Seth GS Medical College and KEM Hospital, Mumbai, India
| | - Sumaswi Angadi
- Department of Gastroenterology, Nizam's Institute of Medical Sciences, Hyderabad, India
| | - Shivaraj Afzalpurkar
- Department of Gastroenterology, Nanjappa Multispecialty Hospital, Davanagere, India
| | - Sidharth Harindranath
- Department of Gastroenterology, Seth GS Medical College and KEM Hospital, Mumbai, India
| | - Sridhar Sundaram
- Department of Digestive Diseases and Clinical Nutrition, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
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21
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On W, Ahmed W, Everett S, Huggett M, Paranandi B. Utility of interventional endoscopic ultrasound in pancreatic cancer. Front Oncol 2023; 13:1252824. [PMID: 37781196 PMCID: PMC10540845 DOI: 10.3389/fonc.2023.1252824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 08/30/2023] [Indexed: 10/03/2023] Open
Abstract
Endoscopic ultrasound (EUS) has an important role in the management algorithm of patients with pancreatic ductal adenocarcinoma (PDAC), typically for its diagnostic utilities. The past two decades have seen a rapid expansion of the therapeutic capabilities of EUS. Interventional EUS is now one of the more exciting developments within the field of endoscopy. The local effects of PDAC tend to be in anatomical areas which are difficult to target and endoscopy has cemented itself as a key role in managing the clinical sequelae of PDAC. Interventional EUS is increasingly utilized in situations whereby conventional endoscopy is either impossible to perform or unsuccessful. It also adds a different dimension to the host of oncological and surgical treatments for patients with PDAC. In this review, we aim to summarize the various ways in which interventional EUS could benefit patients with PDAC and aim to provide a balanced commentary on the current evidence of interventional EUS in the literature.
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Affiliation(s)
- Wei On
- Department of Gastroenterology, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
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22
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Fugazza A, Andreozzi M, De Marco A, Da Rio L, Colombo M, Spadaccini M, Carrara S, Giacchetto M, Sharma M, Craviotto V, Busacca A, Ferrari C, Repici A. Endoscopy Ultrasound-Guided Biliary Drainage Using Lumen Apposing Metal Stent in Malignant Biliary Obstruction. Diagnostics (Basel) 2023; 13:2788. [PMID: 37685326 PMCID: PMC10487072 DOI: 10.3390/diagnostics13172788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 08/16/2023] [Accepted: 08/24/2023] [Indexed: 09/10/2023] Open
Abstract
This narrative review provides an overview of the application of endoscopic ultrasound-guided biliary drainage (EUS-BD), including EUS-guided gallbladder drainage (EUS-GBD), for the treatment of malignant biliary obstruction. EUS-BD has demonstrated excellent technical and clinical success rates, with lower rates of adverse events when compared with percutaneous trans-hepatic biliary drainage (PTBD). EUS-BD is currently the preferred alternative technique for biliary drainage (BD) in patients with distal malignant biliary obstruction (DMBO) after failed endoscopic retrograde cholangiopancreatography (ERCP). Particularly, this review will focus on EUS-BD performed with the use of lumen apposing metal stent (LAMS). The introduction of these innovative devices, followed by the advent of electrocautery-enhanced LAMS (EC-LAMS), gave the procedure a great technical implementation and a widespread application.
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Affiliation(s)
- Alessandro Fugazza
- Division of Gastroenterology and Digestive Endoscopy, Humanitas Research Hospital–IRCSS, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (A.F.); (M.A.); (A.D.M.); (L.D.R.); (M.C.); (M.S.); (S.C.); (M.G.); (V.C.); (A.B.)
| | - Marta Andreozzi
- Division of Gastroenterology and Digestive Endoscopy, Humanitas Research Hospital–IRCSS, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (A.F.); (M.A.); (A.D.M.); (L.D.R.); (M.C.); (M.S.); (S.C.); (M.G.); (V.C.); (A.B.)
| | - Alessandro De Marco
- Division of Gastroenterology and Digestive Endoscopy, Humanitas Research Hospital–IRCSS, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (A.F.); (M.A.); (A.D.M.); (L.D.R.); (M.C.); (M.S.); (S.C.); (M.G.); (V.C.); (A.B.)
| | - Leonardo Da Rio
- Division of Gastroenterology and Digestive Endoscopy, Humanitas Research Hospital–IRCSS, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (A.F.); (M.A.); (A.D.M.); (L.D.R.); (M.C.); (M.S.); (S.C.); (M.G.); (V.C.); (A.B.)
| | - Matteo Colombo
- Division of Gastroenterology and Digestive Endoscopy, Humanitas Research Hospital–IRCSS, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (A.F.); (M.A.); (A.D.M.); (L.D.R.); (M.C.); (M.S.); (S.C.); (M.G.); (V.C.); (A.B.)
| | - Marco Spadaccini
- Division of Gastroenterology and Digestive Endoscopy, Humanitas Research Hospital–IRCSS, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (A.F.); (M.A.); (A.D.M.); (L.D.R.); (M.C.); (M.S.); (S.C.); (M.G.); (V.C.); (A.B.)
| | - Silvia Carrara
- Division of Gastroenterology and Digestive Endoscopy, Humanitas Research Hospital–IRCSS, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (A.F.); (M.A.); (A.D.M.); (L.D.R.); (M.C.); (M.S.); (S.C.); (M.G.); (V.C.); (A.B.)
| | - Marco Giacchetto
- Division of Gastroenterology and Digestive Endoscopy, Humanitas Research Hospital–IRCSS, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (A.F.); (M.A.); (A.D.M.); (L.D.R.); (M.C.); (M.S.); (S.C.); (M.G.); (V.C.); (A.B.)
| | - Mrigya Sharma
- G.M.E.R.S Medical College & Hospital, Gotri, Vadodara 390021, India
| | - Vincenzo Craviotto
- Division of Gastroenterology and Digestive Endoscopy, Humanitas Research Hospital–IRCSS, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (A.F.); (M.A.); (A.D.M.); (L.D.R.); (M.C.); (M.S.); (S.C.); (M.G.); (V.C.); (A.B.)
| | - Anita Busacca
- Division of Gastroenterology and Digestive Endoscopy, Humanitas Research Hospital–IRCSS, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (A.F.); (M.A.); (A.D.M.); (L.D.R.); (M.C.); (M.S.); (S.C.); (M.G.); (V.C.); (A.B.)
| | - Chiara Ferrari
- Division of Anaesthesiology, Humanitas Research Hospital–IRCCS, Via Manzoni 56, Rozzano, 20089 Milan, Italy;
| | - Alessandro Repici
- Division of Gastroenterology and Digestive Endoscopy, Humanitas Research Hospital–IRCSS, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (A.F.); (M.A.); (A.D.M.); (L.D.R.); (M.C.); (M.S.); (S.C.); (M.G.); (V.C.); (A.B.)
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy
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Teoh AYB, Napoleon B, Kunda R, Arcidiacono PG, Kongkam P, Larghi A, Van der Merwe S, Jacques J, Legros R, Thawee RE, Saxena P, Aerts M, Archibugi L, Chan SM, Fumex F, Kaffes AJ, Ma MTW, Messaoudi N, Rizzatti G, Ng KKC, Ng EKW, Chiu PWY. EUS-Guided Choledocho-duodenostomy Using Lumen Apposing Stent Versus ERCP With Covered Metallic Stents in Patients With Unresectable Malignant Distal Biliary Obstruction: A Multicenter Randomized Controlled Trial (DRA-MBO Trial). Gastroenterology 2023; 165:473-482.e2. [PMID: 37121331 DOI: 10.1053/j.gastro.2023.04.016] [Citation(s) in RCA: 62] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 03/29/2023] [Accepted: 04/11/2023] [Indexed: 05/02/2023]
Abstract
BACKGROUND & AIMS Several studies have compared primary endoscopic ultrasound (EUS)-guided biliary drainage to endoscopic retrograde cholangiopancreatography (ERCP) with insertion of metal stents in unresectable malignant distal biliary obstruction (MDBO) and the results were conflicting. The aim of the current study was to compare the outcomes of the procedures in a large-scale study. METHODS This was a multicenter international randomized controlled study. Consecutive patients admitted for obstructive jaundice due to unresectable MDBO were recruited. Patients were randomly allocated to receive EUS-guided choledocho-duodenostomy (ECDS) or ERCP for drainage. The primary outcome was the 1-year stent patency rate. Other outcomes included technical success, clinical success, adverse events, time to stent dysfunction, reintervention rates, and overall survival. RESULTS Between January 2017 and February 2021, 155 patients were recruited (ECDS 79, ERCP 76). There were no significant differences in 1-year stent patency rates (ECDS 91.1% vs ERCP 88.1%, P = .52). The ECDS group had significantly higher technical success (ECDS 96.2% vs ERCP 76.3%, P < .001), whereas clinical success was similar (ECDS 93.7% vs ERCP 90.8%, P = .559). The median (interquartile range) procedural time was significantly shorter in the ECDS group (ECDS 10 [5.75-18] vs ERCP 25 [14-40] minutes, P < .001). The rate of 30-day adverse events (P = 1) and 30-day mortality (P = .53) were similar. CONCLUSION Both procedures could be options for primary biliary drainage in unresectable MDBO. ECDS was associated with higher technical success and shorter procedural time then ERCP. Primary ECDS may be preferred when difficult ERCPs are anticipated. This study was registered to Clinicaltrials.gov NCT03000855.
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Affiliation(s)
- Anthony Yuen Bun Teoh
- Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China.
| | | | - Rastislav Kunda
- Department of Surgery, Department of Gastroenterology-Hepatology, Department of Advanced Interventional Endoscopy, Universitair Ziekenhuis Brussel UZB, Vrije Universiteit Brussel VUB, Brussels, Belgium; Department of Surgical Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
| | - Paolo Giorgio Arcidiacono
- Pancreato-Biliary Endoscopy and Endosonography Division, Pancreas Translational & Clinical Research Center, San Raffaele Scientific Institute IRCCS, Vita Salute San Raffaele University, Milan, Italy
| | - Pradermchai Kongkam
- Division of Hospital and Ambulatory Medicine and Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Alberto Larghi
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Schalk Van der Merwe
- Department of Gastroenterology and Hepatology, The University of Leuven, Leuven, Belgium
| | - Jeremies Jacques
- Gastroenterology Department, Dupuytren University Hospital, Limoges, France
| | - Romain Legros
- Gastroenterology Department, Dupuytren University Hospital, Limoges, France
| | | | - Payal Saxena
- Department of Gastroenterology, Royal Prince Alfred Hospital, Sidney, Australia
| | - Maridi Aerts
- Department of Gastroenterology-Hepatology, Universitair Ziekenhuis Brussel UZB, Vrije Universiteit Brussel VUB, Brussels, Belgium
| | - Livia Archibugi
- Pancreato-Biliary Endoscopy and Endosonography Division, Pancreas Translational & Clinical Research Center, San Raffaele Scientific Institute IRCCS, Vita Salute San Raffaele University, Milan, Italy
| | - Shannon Melissa Chan
- Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Fabien Fumex
- Hopital Privé Jean Mermoz, Ramsay Santé, Lyon Cedex 08, France
| | - Arthur J Kaffes
- Department of Gastroenterology, Royal Prince Alfred Hospital, Sidney, Australia
| | - Mark Tsz Wah Ma
- Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Nouredin Messaoudi
- Department of Surgery, Universitair Ziekenhuis Brussel UZB, Vrije Universiteit Brussel VUB, Brussels, Belgium
| | - Gianenrico Rizzatti
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Kelvin Kwok Chai Ng
- Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Enders Kwok Wai Ng
- Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Philip Wai Yan Chiu
- Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
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24
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Eisenberg I, Gaidhane M, Kahaleh M, Tyberg A. Drainage Approach for Malignant Biliary Obstruction: A Changing Paradigm. J Clin Gastroenterol 2023; 57:546-552. [PMID: 37079870 DOI: 10.1097/mcg.0000000000001854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/22/2023]
Abstract
Endoscopic retrograde cholangiopancreatography (ERCP) is the standard of care in the management of unresectable malignant biliary obstruction. However, endoscopic ultrasound (EUS)-guided biliary drainage has become widely accepted over the past several years for complicated biliary drainage in cases when ERCP is unsuccessful or not feasible. Recent emerging evidence suggests EUS-guided hepaticogastrostomy and EUS-guided choledochoduodenostomy are noninferior, and possibly even superior to conventional ERCP for primary palliation of malignant biliary obstruction. This article reviews the procedural techniques and considerations of the different techniques as well as comparative literature on safety and efficacy between techniques.
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Affiliation(s)
- Ian Eisenberg
- Division of Gastroenterology and Hepatology, University of Maryland School of Medicine, Baltimore, MD
| | - Monica Gaidhane
- Department of Gastroenterology and Hepatology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Michel Kahaleh
- Department of Gastroenterology and Hepatology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Amy Tyberg
- Department of Gastroenterology and Hepatology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
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25
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Radlinski MJ, Strand DS, Shami VM. Evolution of interventional endoscopic ultrasound. Gastroenterol Rep (Oxf) 2023; 11:goad038. [PMID: 37398926 PMCID: PMC10313421 DOI: 10.1093/gastro/goad038] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 05/19/2023] [Accepted: 06/01/2023] [Indexed: 07/04/2023] Open
Abstract
Endoscopic ultrasound (EUS) has become an indispensable modality for the assessment of the gastrointestinal tract and adjacent structures since its origin in the 1980s. Following the development of the linear echoendoscope, EUS has evolved from a purely diagnostic modality to a sophisticated tool for intervention, with numerous luminal, pancreaticobiliary, and hepatic applications. Broadly, these applications may be subdivided into three categories: transluminal drainage or access procedures, injection therapy, and EUS-guided liver interventions. Transluminal drainage or access procedures include management of pancreatic fluid collection, EUS-guided biliary drainage, EUS-guided bile duct drainage, EUS-guided pancreatic duct drainage, and enteral anastomosis formation. Injection therapies include therapeutic EUS-guided injections for management of malignancies accessible by EUS. EUS-guided liver applications include EUS-guided liver biopsy, EUS-guided portal pressure gradient measurement, and EUS-guided vascular therapies. In this review, we discuss the origins of each of these EUS applications, evolution of techniques leading to the current status, and future directions of EUS-guided interventional therapy.
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Affiliation(s)
- Mark J Radlinski
- Division of Gastroenterology and Hepatology, University of Virginia, Charlottesville, VA, USA
| | - Daniel S Strand
- Division of Gastroenterology and Hepatology, University of Virginia, Charlottesville, VA, USA
| | - Vanessa M Shami
- Corresponding author. Division of Gastroenterology and Hepatology, University of Virginia Health System, Charlottesville, VA 22908, USA. Tel: +1-434-989-4381;
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26
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Armellini E, Metelli F, Anderloni A, Cominardi A, Aragona G, Marini M, Pace F. Lumen-apposing-metal stent misdeployment in endoscopic ultrasound-guided drainages: A systematic review focusing on issues and rescue management. World J Gastroenterol 2023; 29:3341-3361. [PMID: 37377584 PMCID: PMC10292149 DOI: 10.3748/wjg.v29.i21.3341] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 02/01/2023] [Accepted: 05/06/2023] [Indexed: 06/01/2023] Open
Abstract
BACKGROUND The introduction of lumen-apposing metal stents (LAMS) for endoscopic ultrasound (EUS)-guided drainages has marked a turning point in the field of interventional ultrasound and it is gathering worldwide diffusion in different clinical settings. Nevertheless, the procedure may conceal unexpected pitfalls. LAMS misdeployment is the most frequent cause of technical failure and it can be considered a procedure-related adverse event when it hampers the conclusion of the planned procedure or results in significant clinical consequences. Stent misdeployment can be managed successfully by endoscopic rescue maneuvers to allow the completion of the procedure. To date, no standardized indication is available to guide an appropriate rescue strategy depending on the type of procedure or of misdeployment.
AIM To evaluate the incidence of LAMS misdeployment during EUS-guided choledochoduodenostomy (EUS-CDS), gallbladder drainage (EUS-GBD) and pancreatic fluid collections drainage (EUS-PFC) and to describe the endoscopic rescue strategies adopted under the circumstance.
METHODS We conducted a systematic review of the literature on PubMed by searching for studies published up to October 2022. The search was carried out using the exploded medical subject heading terms “lumen apposing metal stent”, “LAMS”, “endoscopic ultrasound” and “choledochoduodenostomy” or “gallbladder” or “pancreatic fluid collections”. We included in the review on-label EUS-guided procedures namely EUS-CDS, EUS-GBD and EUS-PFC. Only those publications reporting EUS-guided LAMS positioning were considered. The studies reporting a technical success rate of 100% and other procedure-related adverse events were considered to calculate the overall rate of LAMS misdeployment, while studies not reporting the causes of technical failure were excluded. Case reports were considered only for the extraction of data regarding the issues of misdeployment and rescue techniques. The following data were collected from each study: Author, year of publication, study design, study population, clinical indication, technical success, reported number of misdeployment, stent type and size, flange misdeployed and type of rescue strategy.
RESULTS The overall technical success rate of EUS-CDS, EUS-GBD and EUS-PFC was 93.7%, 96.1%, and 98.1% respectively. Significant rates of LAMS misdeployment have been reported for EUS-CDS, EUS-GBD and EUS-PFC drainage, respectively 5.8%, 3.4%, and 2.0%. Endoscopic rescue treatment was feasible in 86.8%, 80%, and 96.8% of cases. Non endoscopic rescue strategies were required only in 10.3%, 16% and 3.2% for EUS-CDS, EUS-GBD, and EUS-PFC. The endoscopic rescue techniques described were over-the-wire deployment of a new stent through the created fistula tract in 44.1%, 8% and 64.5% and stent-in-stent in 23.5%, 60%, and 12.9%, respectively for EUS-CDS, EUS-GBD, and EUS-PFC. Further therapeutic option were endoscopic rendezvous in 11.8% of EUS-CDS and repeated procedure of EUS-guided drainage in 16.1% of EUS-PFC.
CONCLUSION LAMS misdeployment is a relatively common adverse event in EUS-guided drainages. There is no consensus on the best rescue approach in these cases and the choice is often made by the endoscopist relying upon the clinical scenario, anatomical characteristics, and local expertise. In this review, we investigated the misdeployment of LAMS for each of the on-label indications focusing on the rescue therapies used, with the aim of providing useful data for endoscopists and to improve patient outcomes.
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Affiliation(s)
- Elia Armellini
- Department of Gastroenterology, ASST-Bergamoest, Seriate 24068, Bergamo, Italy
| | - Flavio Metelli
- Department of Gastroenterology, ASST-Bergamoest, Seriate 24068, Bergamo, Italy
| | - Andrea Anderloni
- Gastroenterology and Digestive Endoscopy Unit, Fondazione IRCCS Policlinico San Matteo, Pavia 27100, Italy
| | - Anna Cominardi
- Department of Gastroenterology, “Guglielmo da Saliceto” Hospital, Piacenza 29121, Italy
| | - Giovanni Aragona
- Department of Gastroenterology, “Guglielmo da Saliceto” Hospital, Piacenza 29121, Italy
| | - Michele Marini
- Department of General Surgery, ASST-Bergamoest, Seriate 24068, Italy
| | - Fabio Pace
- Department of Gastroenterology, ASST-Bergamoest, Seriate 24068, Bergamo, Italy
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27
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Rai P, Udawat P, Chowdhary SD, Gunjan D, Samanta J, Bhatia V, Singla V, Mukewar S, Mehta N, Achanta CR, Dalal A, Sahu MK, Balekuduru A, Bale A, Basha J, Philip M, Rana S, Puri R, Lakhtakia S, Dhir V. Society of Gastrointestinal Endoscopy of India Consensus Guidelines on Endoscopic Ultrasound-Guided Biliary Drainage: Part I (Indications, Outcomes, Comparative Evaluations, Training). JOURNAL OF DIGESTIVE ENDOSCOPY 2023. [DOI: 10.1055/s-0043-1761591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/05/2023] Open
Abstract
AbstractEndoscopic management of bile duct obstruction is a key aspect in gastroenterology practice and has evolved since the first description of biliary cannulation by McCune et al in 1968. Over many decades, the techniques and accessories have been refined and currently, the first-line management for extrahepatic biliary obstruction is endoscopic retrograde cholangiopancreaticography (ERCP). However, even in expert hands the success rate of ERCP reaches up to 95%. In almost 4 to 16% cases, failure to cannulate the bile duct may necessitate other alternatives such as surgical bypass or more commonly percutaneous transhepatic biliary drainage (PTBD). While surgery is associated with high morbidity and mortality, PTBD has a very high reintervention and complication rate (∼80%) and poor quality of life. Almost parallelly, endoscopic ultrasound (EUS) has come a long way from a mere diagnostic tool to a substantial therapeutic option in various pancreatico-biliary diseases. Biliary drainage using EUS-guidance (EUS-BD) has gained momentum since the first report published by Giovannini et al in 2001. The concept of accessing the bile duct through a different route than the papilla, circumventing the shortcomings of PTBD and sometimes bypassing the actual obstruction have enthused a lot of interest in this novel strategy. The three key methods of EUS-BD entail transluminal, antegrade, and rendezvous approach. Over the past decade, with growing experience, EUS-BD has been found to be equivalent to ERCP or PTBD for malignant obstruction with better success rates.EUS-BD, albeit, is not devoid of adverse events and can carry fatal adverse events. However, neither the technique of EUS-BD, nor the accessories and stents for EUS-BD have been standardized.Additionally, different countries and regions have different availability of the accessories making generalizability a difficult task. Thus, technical aspects of this evolving therapy need to be outlined. For these reasons, the Society of Gastrointestinal Endoscopy India deemed it appropriate to develop technical consensus statements for performing safe and successful EUS-BD.
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Affiliation(s)
- Praveer Rai
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Priyanka Udawat
- Institute of Digestive and Liver Care, School of EUS, S. L. Raheja Hospital, Mumbai, Maharashtra, India
| | | | - Deepak Gunjan
- Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi, India
| | - Jayanta Samanta
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Vikram Bhatia
- Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Vikas Singla
- Department of Gastroenterology, Max Superspeciality Hospital, New Delhi, India
| | | | - Nilay Mehta
- Department of Gastroenterology, Zydus Hospital, Ahmedabad, Gujarat, India
| | - Chalapathi Rao Achanta
- Department of Gastroenterology, KIMS ICON Hospital, Vishakhapatnam, Andhra Pradesh, India
| | - Ankit Dalal
- Baldota Institute of Digestive Sciences, Global Hospital, Mumbai, Maharashtra, India
| | - Manoj Kumar Sahu
- Institute of GI Sciences, Apollo Hospitals, Bhubaneshwar, Orissa, India
| | - Avinash Balekuduru
- Department of Gastroenterology, MS Ramaiah Medical College and Hospital, Bengaluru, Karnataka, India
| | - Abhijit Bale
- Department of Medical Gastroenterology, Sapthagiri Institute of Medical Sciences, Bengaluru, Karnataka, India
| | - Jahangir Basha
- Asian Institute of Gastroenterology, AIG Hospitals, Hyderabad, Telangana, India
| | - Mathew Philip
- Department of Gastroenterology, Lisie Hospital, Kochi, Kerala, India
| | - Surinder Rana
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Rajesh Puri
- Institute of Digestive and Hepatobiliary Sciences, Medanta Hospital, Gurugram, Haryana, India
| | - Sundeep Lakhtakia
- Asian Institute of Gastroenterology, AIG Hospitals, Hyderabad, Telangana, India
| | - Vinay Dhir
- Institute of Digestive and Liver Care, School of EUS, S. L. Raheja Hospital, Mumbai, Maharashtra, India
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Vanella G, Bronswijk M, Dell'Anna G, Voermans RP, Laleman W, Petrone MC, van Malenstein H, Fockens P, Arcidiacono PG, van der Merwe S, van Wanrooij RLJ. Classification, risk factors, and management of lumen apposing metal stent dysfunction during follow-up of endoscopic ultrasound-guided choledochoduodenostomy: Multicenter evaluation from the Leuven-Amsterdam-Milan Study Group. Dig Endosc 2023; 35:377-388. [PMID: 36177532 DOI: 10.1111/den.14445] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Accepted: 09/26/2022] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Long-term outcomes of endoscopic ultrasound-guided choledochoduodenostomy (EUS-CDS) performed with lumen apposing metal stents (LAMS) have been poorly evaluated in small or retrospective series, leading to an underestimation of LAMS dysfunction. METHODS All consecutive EUS-CDS performed in three academic referral centers were included in prospectively maintained databases. Technical/clinical success, adverse events (AEs), and dysfunction during follow-up were retrospectively analyzed. Kaplan-Meier analysis was used to estimate dysfunction-free survival (DFS), with Cox proportional hazard regression to evaluate independent predictors of dysfunction. RESULTS Ninety-three patients were included (male 56%; mean age, 70 years [95% confidence interval (CI) 68-72]; pancreatic cancer 81%, metastatic disease 47%). In 67% of procedures, 6 mm LAMS were used. Technical and clinical success were achieved in 97.8% and 93.4% of patients, respectively, with AEs occurring in 9.7% (78% mild/moderate). Dysfunction occurred in 31.8% of patients after a mean of 166 days (95% CI 91-241), with an estimated 6 month and 12 month DFS of 75% and 52%, respectively; mean DFS of 394 (95% CI 307-482) days. Almost all dysfunctions (96%) were successfully managed by endoscopic reintervention. Duodenal invasion (hazard ratio 2.7 [95% CI 1.1-6.8]) was the only independent predictor of dysfunction. CONCLUSIONS Endoscopic ultrasound-guided choledochoduodenostomy shows excellent initial efficacy and safety, although stent dysfunctions occurs frequently during long-term follow-up. Almost all stent dysfunctions can be managed successfully by endoscopic reinterventions. We propose a comprehensive classification of the different types of dysfunction that may be encountered and rescue procedures that may be employed under these circumstances. Duodenal invasion seems to increase the risk of developing EUS-CDS dysfunction, potentially representing a relative contraindication for this technique.
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Affiliation(s)
- Giuseppe Vanella
- Pancreatobiliary Endoscopy and Endosonography Division, Pancreas Translational and Clinical Research Centre, IRCCS San Raffaele Scientific Institute and University, Milan, Italy
| | - Michiel Bronswijk
- Department of Gastroenterology and Hepatology, University Hospitals Gasthuisberg, University of Leuven, Leuven, Belgium
- Department of Gastroenterology and Hepatology, Imelda General Hospital, Bonheiden, Belgium
| | - Giuseppe Dell'Anna
- Pancreatobiliary Endoscopy and Endosonography Division, Pancreas Translational and Clinical Research Centre, IRCCS San Raffaele Scientific Institute and University, Milan, Italy
| | - Rogier P Voermans
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, The Netherlands
| | - Wim Laleman
- Department of Gastroenterology and Hepatology, University Hospitals Gasthuisberg, University of Leuven, Leuven, Belgium
| | - Maria Chiara Petrone
- Pancreatobiliary Endoscopy and Endosonography Division, Pancreas Translational and Clinical Research Centre, IRCCS San Raffaele Scientific Institute and University, Milan, Italy
| | - Hannah van Malenstein
- Department of Gastroenterology and Hepatology, University Hospitals Gasthuisberg, University of Leuven, Leuven, Belgium
| | - Paul Fockens
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, The Netherlands
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, Vrije Universiteit, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, The Netherlands
| | - Paolo Giorgio Arcidiacono
- Pancreatobiliary Endoscopy and Endosonography Division, Pancreas Translational and Clinical Research Centre, IRCCS San Raffaele Scientific Institute and University, Milan, Italy
| | - Schalk van der Merwe
- Department of Gastroenterology and Hepatology, University Hospitals Gasthuisberg, University of Leuven, Leuven, Belgium
| | - Roy L J van Wanrooij
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, Vrije Universiteit, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, The Netherlands
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Paduano D, Facciorusso A, De Marco A, Ofosu A, Auriemma F, Calabrese F, Tarantino I, Franchellucci G, Lisotti A, Fusaroli P, Repici A, Mangiavillano B. Endoscopic Ultrasound Guided Biliary Drainage in Malignant Distal Biliary Obstruction. Cancers (Basel) 2023; 15:490. [PMID: 36672438 PMCID: PMC9856645 DOI: 10.3390/cancers15020490] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Revised: 01/08/2023] [Accepted: 01/09/2023] [Indexed: 01/15/2023] Open
Abstract
Malignant biliary obstruction (MBO) is a challenging medical problem that often negatively impacts the patient's quality of life (QoL), postoperative complications, and survival rates. Endoscopic approaches to biliary drainage are generally performed by ERCP or, in selected cases, with a percutaneous transhepatic biliary drainage (PTBD). Recent advances in therapeutic endoscopic ultrasound (EUS) allow drainage where previous methods have failed. EUS has evolved from a purely diagnostic technique to one that allows a therapeutic approach in the event of ERCP failure in distal MBO. Moreover, the introduction of dedicated accessories and prostheses for EUS-guided transmural biliary drainage (EUS-BD) made these procedures more successful with regard to technical success, clinical outcomes and reduction of adverse events (AEs). Finally, lumen-apposing metal stents (LAMS) have improved the therapeutic role of the EUS. Subsequently, the electrocautery enhanced tip of the LAMS (EC-LAMS) allows a direct access of the delivery system to the target lumen, thereby simplifying and reducing the EUS-BD procedure time. EUS-BD using LAMS and EC-LAMS has proven effective and safe with a low rate of AEs. This review aims to evaluate biliary drainage techniques in malignant obstruction, focusing on the role of EUS biliary drainage by LAMS.
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Affiliation(s)
- Danilo Paduano
- Gastrointestinal Endoscopy Unit, Humanitas Mater Domini, 21053 Castellanza, Italy
| | - Antonio Facciorusso
- Gastroenterology Unit, Department of Surgical and Medical Sciences, University of Foggia, 71122 Foggia, Italy
- Gastroenterology and Digestive Endoscopy Unit, Department of Medicine, The Pancreas Institute, University Hospital of Verona, 37100 Verona, Italy
| | - Alessandro De Marco
- Endoscopy Unit, Humanitas Clinical and Research Center IRCCS, 20089 Rozzano, Italy
| | - Andrew Ofosu
- Division of Gastroenterology and Hepatology, University of Cincinnati, Cincinnati, OH 45201, USA
| | - Francesco Auriemma
- Gastrointestinal Endoscopy Unit, Humanitas Mater Domini, 21053 Castellanza, Italy
| | - Federica Calabrese
- Gastrointestinal Endoscopy Unit, Humanitas Mater Domini, 21053 Castellanza, Italy
| | - Ilaria Tarantino
- Endoscopy Service, Department of Diagnostic and Therapeutic Services, IRCCS-ISMETT, 90100 Palermo, Italy
| | | | - Andrea Lisotti
- Gastroenterology Unit, Hospital of Imola, University of Bologna, 40121 Bologna, Italy
| | - Pietro Fusaroli
- Gastroenterology Unit, Hospital of Imola, University of Bologna, 40121 Bologna, Italy
| | - Alessandro Repici
- Endoscopy Unit, Humanitas Clinical and Research Center IRCCS, 20089 Rozzano, Italy
- Department of Biomedical Sciences, Humanitas University, 20089 Rozzano, Italy
| | - Benedetto Mangiavillano
- Gastrointestinal Endoscopy Unit, Humanitas Mater Domini, 21053 Castellanza, Italy
- Department of Biomedical Sciences, Humanitas University, 20089 Rozzano, Italy
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Mezzina N, Salerno R. Response. VIDEOGIE : AN OFFICIAL VIDEO JOURNAL OF THE AMERICAN SOCIETY FOR GASTROINTESTINAL ENDOSCOPY 2022; 7:467-468. [PMID: 36467534 PMCID: PMC9716571 DOI: 10.1016/j.vgie.2022.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Nicolò Mezzina
- Gastroenterology and Digestive Endoscopy Unit, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Raffaele Salerno
- Gastroenterology and Digestive Endoscopy Unit, ASST Fatebenefratelli Sacco, Milan, Italy
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31
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Yi H, Liu Q, He S, Zhong L, Wu SH, Guo XD, Ning B. Current uses of electro-cautery lumen apposing metal stents in endoscopic ultrasound guided interventions. Front Med (Lausanne) 2022; 9:1002031. [PMID: 36530880 PMCID: PMC9747751 DOI: 10.3389/fmed.2022.1002031] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Accepted: 11/11/2022] [Indexed: 09/10/2023] Open
Abstract
The electro-cautery lumen apposing metal stent (EC-LAMS) is a newly developed device that integrates the electro-cautery cyctotome with the one-step metal stent delivery and releasing system in recent years. LAMS was first designed to complete the drainage of pancreatic fluid collection under endoscopic ultrasound guidance, and the technological innovation of EC-LAMS has made more off-labeled indications of endoscopic intervention for gastrointestinal diseases realized, such as abdominal fluid drainage, bile duct, or gallbladder drainage through stomach or duodenum, gastrointestinal anastomosis, and the establishment of fistulous channel for further endoscopic operation when necessary. The unique feature of this metal stent is that it has the design of a saddle shape and a large lumen, and can almost connect the adjacent structures to minimize the risk of perforation and leakage. Compared with traditional LAMS, EC-LAMS, an advanced integrated device, can greatly simplify the endoscopic process, shorten the procedure time and reduce the technical difficulty, thus it can help endoscopists complete more complex endoscopic interventions. In this review, we discuss the state of art with regard to EC-LAMS and its endoscopic process, current indications, outcomes, adverse events, and future application prospects.
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Affiliation(s)
- Hang Yi
- Department of Gastroenterology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qin Liu
- Department of Gastroenterology, Chongqing General Hospital, Chongqing, China
| | - Song He
- Department of Gastroenterology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Li Zhong
- Department of Gastroenterology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Su-hua Wu
- Department of Gastroenterology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xiao-dong Guo
- Department of Gastroenterology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Bo Ning
- Department of Gastroenterology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Abstract
PURPOSE OF REVIEW To summarize the current status and future perspectives of the endoscopic management of biliary strictures. RECENT FINDINGS In addition to conventional diagnostic modalities, such as cross-sectional imaging and endoscopic ultrasonography (EUS), per-oral cholangioscopy is helpful for indeterminate biliary strictures. It allows direct visualization of the biliary tract and targeted biopsy. For distal malignant biliary obstruction (MBO), a self-expandable metal stent (SEMS) via endoscopic retrograde cholangiopancreatography (ERCP) is a standard of care. EUS-guided biliary drainage (EUS-BD) is an emerging alternative to percutaneous transhepatic biliary drainage in cases with failed ERCP. EUS-BD is also an effective salvage option for perihilar MBO, which can not be managed via ERCP or percutaneous transhepatic biliary drainage. Preoperative drainage is necessary for most jaundiced patients as neoadjuvant chemotherapy is widely administered for resectable and borderline resectable pancreatic cancer, and a SEMS is preferred in this setting, too. For benign biliary strictures, a covered SEMS can improve stricture resolution and reduce the number of endoscopic sessions as compared to plastic stents. SUMMARY ERCP and EUS play a central role in the diagnosis and drainage for both malignant and benign biliary strictures.
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Kim BS, Yang SY, Lee WD, Song JS, Yang MA, Jung GM, Cho JW, Kim JW. Endoscopic Ultrasonography-guided Gastrojejunostomy for Patients with Gastric Outlet Obstruction and Pyloric Metal Stent Dysfunction. THE KOREAN JOURNAL OF GASTROENTEROLOGY = TAEHAN SOHWAGI HAKHOE CHI 2022; 79:260-264. [PMID: 35746840 DOI: 10.4166/kjg.2022.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 04/03/2022] [Accepted: 04/19/2022] [Indexed: 06/15/2023]
Abstract
A 52-year-old woman with a gastric outlet obstruction (GOO) caused by pyloric cancer underwent pyloric endoscopic self-expandable metal stent (SEMS) insertion. She presented with abdominal distension 40 days later. The SEMS was dysfunctional, and endoscopic ultrasound-guided gastrojejunostomy (EUS-GJ) was performed using an endoscopic nasobiliary drainage tube. A 16 mm×31 mm Niti-S ™ HOT SPAXUS™ (TaeWoong Medical, Gimpo, Korea) was inserted successfully between the stomach and the adjacent jejunum. After the procedure, the patient had a good oral intake for more than seven months. GOO is a mechanical obstructive condition caused by various benign and malignant conditions. Traditionally, surgical GJ and SEMS insertion have been used to treat GOOs. EUS-GJ is a feasible treatment option for patients with GOO and a pyloric metal stent dysfunction.
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Affiliation(s)
- Byung Sun Kim
- Department of Internal Medicine, Presbyterian Medical Center, Jeonju, Korea
| | - Sung Yeol Yang
- Department of Internal Medicine, Presbyterian Medical Center, Jeonju, Korea
| | - Won Dong Lee
- Department of Internal Medicine, Presbyterian Medical Center, Jeonju, Korea
| | - Jae Sun Song
- Department of Internal Medicine, Presbyterian Medical Center, Jeonju, Korea
| | - Min A Yang
- Department of Internal Medicine, Presbyterian Medical Center, Jeonju, Korea
| | - Gum Mo Jung
- Department of Internal Medicine, Presbyterian Medical Center, Jeonju, Korea
| | - Jin Woong Cho
- Department of Internal Medicine, Presbyterian Medical Center, Jeonju, Korea
| | - Ji Woong Kim
- Department of Internal Medicine, Presbyterian Medical Center, Jeonju, Korea
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Choi JH, Kozarek RA, Larsen MC, Ross AS, Law JK, Krishnamoorthi R, Irani S. Effectiveness and Safety of Lumen-Apposing Metal Stents in Endoscopic Interventions for Off-Label Indications. Dig Dis Sci 2022; 67:2327-2336. [PMID: 34718905 DOI: 10.1007/s10620-021-07270-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 08/07/2021] [Indexed: 12/09/2022]
Abstract
BACKGROUND Although released only for drainage of pseudocyst and walled-off necrosis (WON) with ≤ 30% solid debris, the utilization of lumen-apposing metal stent (LAMS) in "real-world" practice has deviated from approved indications. We evaluated the contemporary use of LAMS and associated clinical, procedural outcomes in the setting of a tertiary referral center in the USA. METHODS Data from 303 consecutive patients who underwent LAMS placement were analyzed. Outcomes included technical and clinical success rates and adverse events. RESULTS Of 303 patients, 190 (62.7%) received LAMS for off-label indications. The latter included gallbladder drainage (n = 56, 18.5%), gastroenterostomy (n = 52, 17.2%), treatment of gastrointestinal strictures (n = 37, 12.2%), biliary drainage (n = 20, 6.6%), temporary gastric access for endoscopy (n = 13, 4.3%), symptomatic WON with > 30% solid debris (n = 8, 2.6%), and miscellaneous (n = 4, 1.3%). Technical success rates in the on- and off-label arm were 98.2% and 95.8%, respectively (P = .331; 95% CI 0.08 to 1.96). Clinical success rates in the on- and off-label arm were 89.4% and 83.2%, respectively (P = .137; 95% CI 0.28 to 1.19). The rate of adverse events was 20.5% (n = 39) in the off-label arm and 16.8% (n = 19) in the on-label arm (P = .242; 95% CI 0.69 to 2.34). CONCLUSION Off-label use of LAMS out-numbered on-label use in our practice. The safety profile between the groups was similar and with the exception of refractory stricture treatment, efficacy was comparable.
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Affiliation(s)
- Jun-Ho Choi
- Department of Gastroenterology, Digestive Disease Institute, Virginia Mason Medical Center, Seattle, WA, USA
- Department of Gastroenterology, Dankook University Hospital, Dankook University College of Medicine, 201 Manghyang-ro, Dongnam-gu, Cheonan, 31116, Korea
| | - Richard A Kozarek
- Department of Gastroenterology, Digestive Disease Institute, Virginia Mason Medical Center, Seattle, WA, USA
- Digestive Disease Institute, Virginia Mason Medical Center, 1100 Ninth Ave., Mailstop C3-GAS, Seattle, WA, 98101, USA
| | - Michael C Larsen
- Department of Gastroenterology, Digestive Disease Institute, Virginia Mason Medical Center, Seattle, WA, USA
- Digestive Disease Institute, Virginia Mason Medical Center, 1100 Ninth Ave., Mailstop C3-GAS, Seattle, WA, 98101, USA
| | - Andrew S Ross
- Department of Gastroenterology, Digestive Disease Institute, Virginia Mason Medical Center, Seattle, WA, USA
- Digestive Disease Institute, Virginia Mason Medical Center, 1100 Ninth Ave., Mailstop C3-GAS, Seattle, WA, 98101, USA
| | - Joanna K Law
- Department of Gastroenterology, Digestive Disease Institute, Virginia Mason Medical Center, Seattle, WA, USA
- Digestive Disease Institute, Virginia Mason Medical Center, 1100 Ninth Ave., Mailstop C3-GAS, Seattle, WA, 98101, USA
| | - Rajesh Krishnamoorthi
- Department of Gastroenterology, Digestive Disease Institute, Virginia Mason Medical Center, Seattle, WA, USA
- Digestive Disease Institute, Virginia Mason Medical Center, 1100 Ninth Ave., Mailstop C3-GAS, Seattle, WA, 98101, USA
| | - Shayan Irani
- Department of Gastroenterology, Digestive Disease Institute, Virginia Mason Medical Center, Seattle, WA, USA.
- Division of Gastroenterology and Hepatology, Virginia Mason Medical Center, 1100 Ninth Ave., Mailstop C3-GAS, Seattle, WA, 98101, USA.
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Di Mitri R, Amata M, Mocciaro F, Conte E, Bonaccorso A, Scrivo B, Scimeca D. EUS-guided biliary drainage with LAMS for distal malignant biliary obstruction when ERCP fails: single-center retrospective study and maldeployment management. Surg Endosc 2022; 36:4553-4569. [PMID: 34724586 DOI: 10.1007/s00464-021-08808-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Accepted: 10/17/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND EUS-guided biliary drainage (EUS-BD) with Lumen Apposing Metal Stent (LAMS) is a mini-invasive approach for jaundice palliation in distal malignant biliary obstruction (D-MBO) not amenable to ERCP, with good efficacy and not exiguous adverse events. AIMS AND METHODS From January 2015 to December 2019, we retrospectively enrolled all the EUS-BD with electrocautery-enhanced LAMS for biliary decompression in unresectable D-MBO and failed ERCP. Primary study aims were to evaluate technical/clinical success and AEs rate. In case of maldeployment, we estimated the efficacy of an intra-operative rescue therapy. Secondary aims were to assess the jaundice recurrence and gastric outlet obstruction symptoms. RESULTS Thirty-six EUS-BD were enrolled over a cohort of 738 patients (ERCP cannulation failure rate was 2.6%): 31 choledocho-duodenostomy and 5 cholecystogastrostomy. A pre-loaded guidewire through the LAMS was systematically used in case of common bile duct ≤ 15 mm or scope instability for a safe/preventive biliary entryway in case of intra-procedural complications. Technical success was 80.6% (29/36 patients). Seven cases of LAMS maldeployment during EUS-guided choledocho-duodenostomy were successfully treated with RT by an over-the-wire fully-covered Self-Expandable Metal Stent (FC-SEMS). The FC-SEMS was released through the novel fistula tract in endoscopic fashion in 5/7 cases and transpapillary in percutaneous-transhepatic-endoscopic rendezvous (1/7) and laparoscopic-endoscopic rendezvous (1/7) in the two remaining cases. The total efficacy of rescue therapy was 100%. Same-session duodenal SEMS was placed in 17 patients with optimal gastric outlet obstruction management. Final clinical success was 100% and no other late adverse events or FC-SEMS migration were observed. CONCLUSION EUS-BD with LAMS is effective for jaundice palliation after ERCP failure but with considerable adverse events. Maldeployment remains a serious complication with fatal evolution if not correctly recognized/managed. Rescue therapy must be promptly applied especially in tertiary-care centers with highly skilled endoscopists, interventional radiologist and dedicated surgeon.
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Affiliation(s)
- Roberto Di Mitri
- Gastroenterology and Endoscopy Unit, ARNAS Civico-Di Cristina-Benfratelli Hospital, Piazza Nicola Leotta 4, 901200, Palermo, Italy
| | - Michele Amata
- Gastroenterology and Endoscopy Unit, ARNAS Civico-Di Cristina-Benfratelli Hospital, Piazza Nicola Leotta 4, 901200, Palermo, Italy.
| | - Filippo Mocciaro
- Gastroenterology and Endoscopy Unit, ARNAS Civico-Di Cristina-Benfratelli Hospital, Piazza Nicola Leotta 4, 901200, Palermo, Italy
| | - Elisabetta Conte
- Gastroenterology and Endoscopy Unit, ARNAS Civico-Di Cristina-Benfratelli Hospital, Piazza Nicola Leotta 4, 901200, Palermo, Italy
| | - Ambra Bonaccorso
- Gastroenterology and Endoscopy Unit, ARNAS Civico-Di Cristina-Benfratelli Hospital, Piazza Nicola Leotta 4, 901200, Palermo, Italy
| | - Barbara Scrivo
- Gastroenterology and Endoscopy Unit, ARNAS Civico-Di Cristina-Benfratelli Hospital, Piazza Nicola Leotta 4, 901200, Palermo, Italy
| | - Daniela Scimeca
- Gastroenterology and Endoscopy Unit, ARNAS Civico-Di Cristina-Benfratelli Hospital, Piazza Nicola Leotta 4, 901200, Palermo, Italy
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Koga T, Hijioka S, Nagashio Y, Ohba A, Maruki Y, Yoshinari M, Hisada Y, Harai S, Kitamura H, Maehara K, Murashima Y, Kawasaki Y, Kawahara S, Takeshita K, Yamada N, Satake T, Kondo S, Morizane C, Ueno H, Okusaka T, Saito Y. Endoscopic ultrasound‐guided choledochoduodenostomy without fistula dilation using a stent with a 5.9‐Fr delivery system: Comparison to a conventional procedure with fistula dilation. DEN OPEN 2022; 2:e56. [PMID: 35310726 PMCID: PMC8828169 DOI: 10.1002/deo2.56] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 08/19/2021] [Accepted: 08/22/2021] [Indexed: 11/24/2022]
Abstract
Objectives To evaluate the feasibility and safety of endoscopic ultrasound‐guided choledochoduodenostomy (EUS‐CDS) without fistula dilation using a novel self‐expandable metal stent (SEMS). Methods This retrospective study examined patients who underwent EUS‐CDS for malignant distal biliary obstruction between October 2017 and May 2021 at the National Cancer Center, Japan. The primary outcome was a technical success without fistula dilation. Secondary outcomes were the overall technical success, clinical success, adverse events (AEs), procedure time, recurrent biliary obstruction (RBO), and time to RBO (TRBO). Results Forty‐one patients were enrolled; 31 patients underwent EUS‐CDS with fistula dilation using a conventional SEMS with 7.5–8.5‐Fr delivery system (conventional SEMS group), and 10 patients underwent EUS‐CDS without fistula dilation using the novel SEMS with a 5.9‐Fr delivery system (novel SEMS group). In the novel SEMS group, the rate of technical success without fistula dilation was 90%. There were no differences in overall technical success (100% vs. 97%, p = 1.00), clinical success (80% vs. 90%, p = 0.58), and overall AEs (10% vs. 23%, p = 0.65) rates between the novel and conventional SEMS groups. In the novel SEMS group, no early AEs were observed and no bile leakage into the abdominal cavity was observed on the computed tomography scan after the procedure. The median procedure time was significantly shorter in the novel SEMS group (17 min vs. 24 min, p = 0.03). RBO and median TRBO did not differ between the 2 groups. Conclusions EUS‐CDS without fistula dilation using the novel SEMS with a 5.9‐Fr delivery system is technically feasible, straightforward, quick, and safe.
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Affiliation(s)
- Takehiko Koga
- Department of Hepatobiliary and Pancreatic Oncology National Cancer Center Hospital Tokyo Japan
| | - Susumu Hijioka
- Department of Hepatobiliary and Pancreatic Oncology National Cancer Center Hospital Tokyo Japan
| | - Yosikuni Nagashio
- Department of Hepatobiliary and Pancreatic Oncology National Cancer Center Hospital Tokyo Japan
| | - Akihiro Ohba
- Department of Hepatobiliary and Pancreatic Oncology National Cancer Center Hospital Tokyo Japan
| | - Yuta Maruki
- Department of Hepatobiliary and Pancreatic Oncology National Cancer Center Hospital Tokyo Japan
| | - Motohiro Yoshinari
- Department of Hepatobiliary and Pancreatic Oncology National Cancer Center Hospital Tokyo Japan
| | - Yuya Hisada
- Department of Hepatobiliary and Pancreatic Oncology National Cancer Center Hospital Tokyo Japan
| | - Shota Harai
- Department of Hepatobiliary and Pancreatic Oncology National Cancer Center Hospital Tokyo Japan
| | - Hidetoshi Kitamura
- Department of Hepatobiliary and Pancreatic Oncology National Cancer Center Hospital Tokyo Japan
| | - Kosuke Maehara
- Department of Hepatobiliary and Pancreatic Oncology National Cancer Center Hospital Tokyo Japan
| | - Yumi Murashima
- Department of Hepatobiliary and Pancreatic Oncology National Cancer Center Hospital Tokyo Japan
| | - Yuki Kawasaki
- Department of Hepatobiliary and Pancreatic Oncology National Cancer Center Hospital Tokyo Japan
| | - Shun Kawahara
- Department of Hepatobiliary and Pancreatic Oncology National Cancer Center Hospital Tokyo Japan
| | - Kotaro Takeshita
- Department of Hepatobiliary and Pancreatic Oncology National Cancer Center Hospital Tokyo Japan
| | - Natsumi Yamada
- Department of Hepatobiliary and Pancreatic Oncology National Cancer Center Hospital Tokyo Japan
| | - Tomoyuki Satake
- Department of Hepatobiliary and Pancreatic Oncology National Cancer Center Hospital Tokyo Japan
| | - Shunsuke Kondo
- Department of Hepatobiliary and Pancreatic Oncology National Cancer Center Hospital Tokyo Japan
| | - Chigusa Morizane
- Department of Hepatobiliary and Pancreatic Oncology National Cancer Center Hospital Tokyo Japan
| | - Hideki Ueno
- Department of Hepatobiliary and Pancreatic Oncology National Cancer Center Hospital Tokyo Japan
| | - Takuji Okusaka
- Department of Hepatobiliary and Pancreatic Oncology National Cancer Center Hospital Tokyo Japan
| | - Yutaka Saito
- Endoscopy Division National Cancer Center Hospital Tokyo Japan
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Salerno R, Mezzina N, Carmagnola S, Ardizzone S. Endoscopic management of recurrent cholangitis following EUS-guided choledochoduodenostomy. VideoGIE 2022; 7:185-186. [PMID: 35585895 PMCID: PMC9108114 DOI: 10.1016/j.vgie.2022.01.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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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. Gastrointest Endosc 2022; 95:432-442. [PMID: 34637805 DOI: 10.1016/j.gie.2021.09.040] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 09/27/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS EUS-guided choledochoduodenostomy (EUS-CDD) with an electrocautery-enhanced lumen-apposing metal stent (EC-LAMS) has emerged as a viable method of establishing biliary drainage in patients with malignant distal biliary obstruction (MDBO). Our aim was to assess the efficacy, safety, and outcomes in patients with MDBO who underwent EUS-CDD with an EC-LAMS. METHODS A retrospective review of consecutive patients with MDBO who underwent EUS-CDD with EC-LAMSs at 8 tertiary institutions across the United Kingdom and Ireland between September 2016 and November 2020 was undertaken. RESULTS One hundred twenty patients (55% men) with a median age of 73 years (interquartile range, 17; range, 43-94) were included. The median follow-up period in 117 patients was 70 days (interquartile range, 169; range, 3-869), and 23 patients (19.2%) were alive at the end of the follow-up. Three patients were lost to follow-up. Technical success was achieved in 109 patients (90.8%). Clinical success (reduction of serum bilirubin to ≤50% of original value within 14 days) was achieved in 94.8% of patients (92/97). The adverse event rate was 17.5% (n = 21). Biliary reintervention after initial technical success was required in 9 patients (8.3%). CONCLUSIONS EUS-CDD with EC-LAMSs at tertiary institutions within a regional hepatopancreatobiliary network for treatment of MDBO was effective in those where ERCP was not possible or was unsuccessful. When technical failures or adverse events occur, most patients can be managed with conservative or endoscopic therapy.
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Garcia-Sumalla A, Loras C, Sanchiz V, Sanz RP, Vazquez-Sequeiros E, Aparicio JR, de la Serna-Higuera C, Luna-Rodriguez D, Andujar X, Capilla M, Barberá T, Foruny-Olcina JR, Martínez B, Dura M, Salord S, Laquente B, Tebe C, Videla S, Perez-Miranda M, Gornals JB. 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. Trials 2022; 23:181. [PMID: 35216619 PMCID: PMC8874735 DOI: 10.1186/s13063-022-06106-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Accepted: 02/12/2022] [Indexed: 11/18/2022] Open
Abstract
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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Affiliation(s)
- Albert Garcia-Sumalla
- Endoscopy Unit, Department of Digestive Diseases, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Catalonia, Spain
- Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain
- University of Barcelona, Barcelona, Spain
| | - Carme Loras
- Endoscopy Unit, Department of Digestive Diseases, Hospital Universitari Mútua Terrassa, Fundació per la Recerca Mútua Terrassa, CIBERehd, Terrassa, Spain
- Health Sciences, Universitat Oberta de Catalunya, Barcelona, Spain
| | - Vicente Sanchiz
- Endoscopy Unit, Department of Digestive Diseases, Hospital Clínico Universitario de Valencia, Instituto de Investigación Sanitaria INCLIVA, Valencia, Spain
| | - Rafael Pedraza Sanz
- Endoscopy Unit, Department of Digestive Diseases Endoscopy Unit, Hospital General Universitario de Castellón, Castelló de la Plana, Spain
| | - Enrique Vazquez-Sequeiros
- Endoscopy Unit, Gastroenterology and Hepatology Service, Hospital Ramon y Cajal, IRYCIS, Madrid, Spain
| | - Jose Ramon Aparicio
- Endoscopy Unit, Department of Digestive Diseases, Hospital General Universitario de Alicante; Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain
| | | | - Daniel Luna-Rodriguez
- Endoscopy Unit, Department of Digestive Diseases, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Catalonia, Spain
- Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain
- University of Barcelona, Barcelona, Spain
| | - Xavier Andujar
- Endoscopy Unit, Department of Digestive Diseases, Hospital Universitari Mútua Terrassa, Fundació per la Recerca Mútua Terrassa, CIBERehd, Terrassa, Spain
| | - María Capilla
- Endoscopy Unit, Department of Digestive Diseases, Hospital Clínico Universitario de Valencia, Instituto de Investigación Sanitaria INCLIVA, Valencia, Spain
| | - Tatiana Barberá
- Endoscopy Unit, Department of Digestive Diseases Endoscopy Unit, Hospital General Universitario de Castellón, Castelló de la Plana, Spain
| | - Jose Ramon Foruny-Olcina
- Endoscopy Unit, Gastroenterology and Hepatology Service, Hospital Ramon y Cajal, IRYCIS, Madrid, Spain
| | - Belen Martínez
- Endoscopy Unit, Department of Digestive Diseases, Hospital General Universitario de Alicante; Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain
| | - Miguel Dura
- Endoscopy Unit, Department of Digestive Diseases, Hospital Universitario Rio Hortega, Valladolid, Spain
| | - Silvia Salord
- Hepato-Bilio-Pancreatic Unit, Digestive Diseases Department, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Catalonia, Spain
| | - Berta Laquente
- Clinical Oncology Department, Hospital Duran y Reynalds, Institu Oncologic de Catalunya, Barcelona, Catalonia, Spain
| | - Cristian Tebe
- Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain
- Biostatistics Unit, Institute of Biomedical Research of Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Sebastia Videla
- Endoscopy Unit, Department of Digestive Diseases, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Catalonia, Spain
- Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain
- University of Barcelona, Barcelona, Spain
- Clinical Research and Clinical Trial Unit (UICEC), Clinical Pharmacology Department, Hospital Universitari de Bellvitge, Barcelona, Catalonia, Spain
| | - Manuel Perez-Miranda
- Endoscopy Unit, Department of Digestive Diseases, Hospital General Universitario de Alicante; Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain
| | - Joan B Gornals
- Endoscopy Unit, Department of Digestive Diseases, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Catalonia, Spain.
- Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain.
- University of Barcelona, Barcelona, Spain.
- Health Sciences, Universitat Oberta de Catalunya, Barcelona, Spain.
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van der Merwe SW, van Wanrooij RLJ, Bronswijk M, Everett S, Lakhtakia S, Rimbas M, Hucl T, Kunda R, Badaoui A, Law R, Arcidiacono PG, Larghi A, Giovannini M, Khashab MA, Binmoeller KF, Barthet M, Perez-Miranda M, van Hooft JE. Therapeutic endoscopic ultrasound: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy 2022; 54:185-205. [PMID: 34937098 DOI: 10.1055/a-1717-1391] [Citation(s) in RCA: 256] [Impact Index Per Article: 85.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
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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Affiliation(s)
- Schalk W van der Merwe
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
| | - Roy L J van Wanrooij
- Department of Gastroenterology and Hepatology, Amsterdam UMC, Vrije Universiteit Amsterdam, AGEM Institute, Amsterdam, The Netherlands
| | - Michiel Bronswijk
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
- Department of Gastroenterology and Hepatology, Imelda General Hospital, Bonheiden, Belgium
| | - Simon Everett
- Department of Gastroenterology and Hepatology, Leeds Teaching Hospital NHS Trust, Leeds, UK
| | - Sundeep Lakhtakia
- Department of Medical Gastroenterology, Asian Institute of Gastroenterology Hospitals, Gachibowli, Hyderabad, India
| | - Mihai Rimbas
- Gastroenterology Department, Colentina Clinical Hospital, Bucharest, Romania
| | - Tomas Hucl
- Department of Gastroenterology and Hepatology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Rastislav Kunda
- Department of Surgery, Department of Gastroenterology and Hepatology, and Department of Advanced Interventional Endoscopy, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Abdenor Badaoui
- Department of Gastroenterology and Hepatology, Université catholique de Louvain, CHU UCL Namur, Yvoir, Belgium
| | - Ryan Law
- Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Paolo G Arcidiacono
- Pancreatobiliary Endoscopy and Endosonography Division, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alberto Larghi
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, and Center for Endoscopic Research Therapeutics and Training (CERTT), Catholic University, Rome, Italy
| | - Marc Giovannini
- Paoli-Calmettes Institute, Department of Gastrointestinal Disease, Marseille, France
| | - Mouen A Khashab
- Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Kenneth F Binmoeller
- Interventional Endoscopy Services, California Pacific Medical Center, San Francisco, California, USA
| | - Marc Barthet
- Department of Gastroenterology, Aix-Marseille Université, APHM, Hôpital Nord, Marseille, France
| | - Manuel Perez-Miranda
- Gastroenterology Department, Hospital Universitario Rio Hortega, Valladolid, Spain
| | - Jeanin E van Hooft
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, The Netherlands
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Bang JY, Hawes R, Varadarajulu S. Endoscopic biliary drainage for malignant distal biliary obstruction: Which is better - endoscopic retrograde cholangiopancreatography or endoscopic ultrasound? Dig Endosc 2022; 34:317-324. [PMID: 34748675 PMCID: PMC9299777 DOI: 10.1111/den.14186] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 10/03/2021] [Accepted: 11/05/2021] [Indexed: 12/13/2022]
Abstract
Presently, following endoscopic ultrasound (EUS)-guided biopsy, an endoscopic retrograde cholangiopancreatography (ERCP) with transpapillary stenting is performed for palliation of malignant distal biliary obstruction (MDBO). However, technical failure and postprocedure pancreatitis are limitations to ERCP. Endoscopic ultrasonography-guided biliary drainage (EUS-BD) after a failed ERCP has a 90% technical success rate and has been shown to be superior when compared to percutaneous methods, making EUS an increasingly recognized option for biliary drainage. Supporting this approach, findings from recently concluded randomized trials suggest that the safety profile and technical outcomes for EUS-BD are comparable or even superior to that of ERCP for primary biliary decompression in patients with MDBO. Also, EUS-BD is increasingly being utilized in patients with altered surgical anatomy in lieu of percutaneous techniques and balloon-assisted enteroscopy. A growing body of evidence supports the notion that, in the future, EUS may become the primary modality by which biliary decompression is undertaken in the majority of patients with MDBO. The roadmap to this eventuality may require further optimization of procedural techniques, technological innovations, and cost reduction.
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Affiliation(s)
| | - Robert Hawes
- Digestive Health InstituteOrlando HealthOrlandoUSA
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de Benito Sanz M, Nájera-Muñoz R, de la Serna-Higuera C, Fuentes-Valenzuela E, Fanjul I, Chavarría C, García-Alonso FJ, Sanchez-Ocana R, Carbajo AY, Bazaga S, Perez-Miranda M. Lumen apposing metal stents versus tubular self-expandable metal stents for endoscopic ultrasound-guided choledochoduodenostomy in malignant biliary obstruction. Surg Endosc 2021; 35:6754-6762. [PMID: 33258038 DOI: 10.1007/s00464-020-08179-y] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 11/15/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND AIMS EUS-guided choledochoduodenostomy (EUS-CDS) is an effective option for biliary drainage in malignant biliary obstruction. Lumen apposing metal stents (LAMS) are increasingly been used for EUS-CDS. It is unknown how LAMS compare to tubular self-expandable metal stents (SEMS) for EUS-CDS. Our aim is to compare the clinical outcomes of LAMS versus SEMS for EUS-CDS. PATIENTS AND METHODS Single-center retrospective cohort study of consecutive patients with unresectable malignant biliary obstruction who underwent EUS-CDS after failed ERCP for initial biliary drainage between 2011 and 2019. Clinical outcomes were compared between patients who had conventional covered SEMS and LAMS placed for EUS-CDS. Outcome measures included unplanned procedural events, technical success, clinical success, adverse events and reinterventions. Survival was analyzed by the Kaplan-Meier method. RESULTS During the study period 57 patients met inclusion criteria (37 LAMS, 20 SEMS). All EUS-CDS were technically successful (LAMS group 95% CI 90.3-100%, SEMS group 95% CI 83.2-100%). There were no differences between groups in unplanned procedural events (4 LAMS deployment issues, 2 mild bleeding in SEMS group; 10 vs 10.8%), clinical success (37/37 [100%] vs 19/20 [95%]), and short-term adverse events (5/37 [13.5%] vs 4/20 [20%], p = 0.71). Complete follow-up data were available in 41 patients for a mean of 376 ± 145 days. Endoscopic reintervention was required for duodenal stent placement (n = 9) or biliary stent dysfunction (n = 4), with no difference between LAMS and SEMS group (6/37 [16.2%] vs 7/20 [35%]). There were no differences in overall survival between both groups. CONCLUSIONS EUS-guided choledochoduodenostomy after failed ERCP has equally high technical and clinical success rates with either LAMS or SEMS in patients with malignant biliary obstruction. No differences in adverse events, reinterventions and survival were seen with either type of stent. The cost-effectiveness of LAMS vs SEMS for EUS-guided choledochoduodenostomy remains to be proven.
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Affiliation(s)
- Marina de Benito Sanz
- Gastroenterology Department, Hospital Universitario Río Hortega, Calle Dulzaina 2, 47012, Valladolid, Spain.
| | - Rodrigo Nájera-Muñoz
- Gastroenterology Department, Hospital Universitario Río Hortega, Calle Dulzaina 2, 47012, Valladolid, Spain
| | - Carlos de la Serna-Higuera
- Gastroenterology Department, Hospital Universitario Río Hortega, Calle Dulzaina 2, 47012, Valladolid, Spain
| | - Esteban Fuentes-Valenzuela
- Gastroenterology Department, Hospital Universitario Río Hortega, Calle Dulzaina 2, 47012, Valladolid, Spain
| | - Ignacio Fanjul
- Gastroenterology Department, Hospital Universitario Río Hortega, Calle Dulzaina 2, 47012, Valladolid, Spain
| | - Carlos Chavarría
- Gastroenterology Department, Hospital Universitario Río Hortega, Calle Dulzaina 2, 47012, Valladolid, Spain
| | | | - Ramón Sanchez-Ocana
- Gastroenterology Department, Hospital Universitario Río Hortega, Calle Dulzaina 2, 47012, Valladolid, Spain
| | - Ana Yaiza Carbajo
- Gastroenterology Department, Hospital Universitario Río Hortega, Calle Dulzaina 2, 47012, Valladolid, Spain
| | - Sergio Bazaga
- Gastroenterology Department, Hospital Universitario Río Hortega, Calle Dulzaina 2, 47012, Valladolid, Spain
| | - Manuel Perez-Miranda
- Gastroenterology Department, Hospital Universitario Río Hortega, Calle Dulzaina 2, 47012, Valladolid, Spain
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Rimbaş M, Anderloni A, Napoléon B, Seicean A, Forti E, Crinò SF, Tarantino I, Arcidiacono PG, Fabbri C, Rizzatti G, Amato A, Voiosu T, Fugazza A, Moșteanu O, Ginès À, de Nucci G, Fusaroli P, Nguyen NQ, Di Mitri R, Minelli Grazioli L, Mutignani M, Archibugi L, Binda C, Cominardi A, Barbera C, Fernández-Esparrach G, Palazzo L, Palazzo M, Poley JW, Spada C, Valerii G, Itoi T, Matsunami Y, Mateescu RB, Băicuș C, Costamagna G, Larghi A. Common bile duct size in malignant distal obstruction and lumen-apposing metal stents: a multicenter prospective study. Endosc Int Open 2021; 9:E1801-E1810. [PMID: 34790548 PMCID: PMC8589552 DOI: 10.1055/a-1526-1208] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Accepted: 05/26/2021] [Indexed: 11/11/2022] Open
Abstract
Background and study aims Feasibility of EUS-guided choledochoduodenostomy (EUS-CDS) using available lumen-apposing stents (LAMS) is limited by the size of the common bile duct (CBD) (≤ 12 mm, cut-off for experts; 15 mm, cut-off for non-experts). We aimed to assess the prevalence and predictive factors associated with CBD size ≥ 12 and 15 mm in naïve patients with malignant distal biliary obstruction (MDBO). Patients and methods This was a prospective cohort study involving 22 centers with assessment of CBD diameter and subjective feasibility of the EUS-CDS performance in naïve jaundiced patients undergoing EUS evaluation for MDBO. Results A total of 491 patients (mean age 69 ± 12 years) with mean serum bilirubin of 12.7 ± 6.6 mg/dL entered the final analysis. Dilation of the CBD ≥ 12 and 15 mm was detected in 78.8 % and 51.9 % of cases, respectively. Subjective feasibility of EUS-CDS was expressed by endosonographers in 91.2 % for a CBD ≥ 12 mm and in 96.5 % for a CBD ≥ 15 mm. On multivariate analysis, age ( P < 0.01) and bilirubin level ( P ≤ 0.001) were the only factors associated with both CBD dilation ≥ 12 and ≥ 15 mm. These variables were poorly associated with the extent of duct dilation; however, based on them a prediction model could be constructed that satisfactorily predicted CBD size ≥ 12 mm in patients at least 70 years and a bilirubin level ≥ 7 mg/dL. Conclusions Our study showed that at presentation in a large cohort of patients with MDBO, EUS-CDS can be potentially performed in three quarters to half of cases by expert and less experienced endosonographers, respectively. Dedicated stents or devices with different designs able to overcome the limitations of existing electrocautery-enhanced LAMS for EUS-CDS are needed.
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Affiliation(s)
- Mihai Rimbaş
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy,Department of Internal Medicine, Carol Davila University of Medicine, Bucharest, Romania
| | - Andrea Anderloni
- Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Clinical and Research Center, IRCCS, Rozzano, Milan, Italy
| | - Bertrand Napoléon
- Endoscopy Unit, Jean Mermoz Private Hospital, Ramsay Generale de Santé, Lyon, France
| | - Andrada Seicean
- Department of Gastroenterology, Regional Institute of Gastroenterology and Hepatology, Iuliu Haţieganu University of Medicine, Cluj-Napoca, Romania
| | - Edoardo Forti
- Digestive Endoscopy Unit, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Stefano Francesco Crinò
- Gastroenterology and Digestive Endoscopy Unit, The Pancreas Institute, G.B. Rossi University Hospital, Verona, Italy
| | - Ilaria Tarantino
- Endoscopy Service, Department of Diagnostic and Therapeutic Services, Istituto Mediterraneo per i Trapianti e Terapie ad alta Specializzazione, Palermo, Italy
| | - Paolo Giorgio Arcidiacono
- Pancreato-Biliary Endoscopy and Endosonography Division, Pancreas Translational & Clinical Research Center, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Carlo Fabbri
- Gastroenterology and Digestive Endoscopy Unit, Forlì-Cesena Hospitals, AUSL Romagna, Italy
| | - Gianenrico Rizzatti
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy,CERTT, Center for Endoscopic Research Therapeutics and Training, Catholic University, Rome, Italy
| | - Arnaldo Amato
- Gastroenterology Division, Valduce Hospital, Como, Italy
| | - Theodor Voiosu
- Gastroenterology Department, Colentina Clinical Hospital, Bucharest, Romania,Department of Internal Medicine, Carol Davila University of Medicine, Bucharest, Romania
| | - Alessandro Fugazza
- Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Clinical and Research Center, IRCCS, Rozzano, Milan, Italy
| | - Ofelia Moșteanu
- Department of Gastroenterology, Regional Institute of Gastroenterology and Hepatology, Iuliu Haţieganu University of Medicine, Cluj-Napoca, Romania
| | - Àngels Ginès
- Endoscopy Unit, Institut de Malalties Digestives i Metabòliques, Hospital Clínic, University of Barcelona, IDIBAPS, CIBEREHD, Barcelona, Spain
| | - Germana de Nucci
- Gastroenterology Unit, ASST Rhodense, Garbagnate Milanese, Italy
| | - Pietro Fusaroli
- Gastroenterology Unit, Hospital of Imola, Department of Medical and Surgical Sciences, University of Bologna, Italy
| | - Nam Quoc Nguyen
- Department of Gastroenterology, Royal Adelaide Hospital, Adelaide, Australia
| | - Roberto Di Mitri
- Gastroenterology and Endoscopy Unit, ARNAS Civico – Di Cristina – Benfratelli, Palermo, Italy
| | | | | | - Livia Archibugi
- Pancreato-Biliary Endoscopy and Endosonography Division, Pancreas Translational & Clinical Research Center, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Cecilia Binda
- Gastroenterology and Digestive Endoscopy Unit, Forlì-Cesena Hospitals, AUSL Romagna, Italy
| | - Anna Cominardi
- Gastroenterology Unit, Hospital of Imola, Department of Medical and Surgical Sciences, University of Bologna, Italy
| | - Carmelo Barbera
- U.O.C. di Gastroenterologia ed Endoscopia Digestiva, Ospedale Giuseppe Mazzini, ASL Teramo, Italy
| | - Glòria Fernández-Esparrach
- Endoscopy Unit, Institut de Malalties Digestives i Metabòliques, Hospital Clínic, University of Barcelona, IDIBAPS, CIBEREHD, Barcelona, Spain
| | | | - Maxime Palazzo
- Digestive Endoscopy Unit, Beaujon University Hospital, Clichy-la-Garenne, France
| | - Jan Werner Poley
- Department of Gastroenterology and Hepatology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Cristiano Spada
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy,Digestive Endoscopy Unit and Gastroenterology, Fondazione Poliambulanza, Brescia, Italia
| | - Giorgio Valerii
- U.O.C. di Gastroenterologia ed Endoscopia Digestiva, Ospedale Giuseppe Mazzini, ASL Teramo, Italy
| | - Takao Itoi
- Department of Gastroenterology and Hepatology, Tokyo Medical University Hospital, Tokyo, Japan
| | - Yukitoshi Matsunami
- Department of Gastroenterology and Hepatology, Tokyo Medical University Hospital, Tokyo, Japan
| | - Radu Bogdan Mateescu
- Gastroenterology Department, Colentina Clinical Hospital, Bucharest, Romania,Department of Internal Medicine, Carol Davila University of Medicine, Bucharest, Romania
| | - Cristian Băicuș
- Department of Internal Medicine, Carol Davila University of Medicine, Bucharest, Romania
| | - Guido Costamagna
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy,CERTT, Center for Endoscopic Research Therapeutics and Training, Catholic University, Rome, Italy
| | - Alberto Larghi
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy,CERTT, Center for Endoscopic Research Therapeutics and Training, Catholic University, Rome, Italy
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Teoh AYB, Kongkam P, Bapaye A, Ratanachu T, Reknimitr R, Lakthakia S, Chan SM, Gadhikar HP, Korrapati SK, Lee YN, Medarapalem J, Ridtitid W, Moon JH. Use of a novel lumen apposing metallic stent for drainage of the bile duct and gallbladder: Long term outcomes of a prospective international trial. Dig Endosc 2021; 33:1139-1145. [PMID: 33284467 DOI: 10.1111/den.13911] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 11/27/2020] [Accepted: 12/02/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Long-term placement of lumen apposing metal stents (LAMS) with high lumen apposing force may result in adverse events. The aim of the current study was to assess the long-term efficacy and safety of a self-approximating LAMS with lower lumen apposing force for endoscopic ultrasound-guided choledochoduodenostomy (EUS-CDS) and -gallbladder drainage (EUS-GBD). METHODS Five Asian institutions participated in this study. Consecutive patients suffering from obstructive jaundice with failed ERCP or acute cholecystitis that were at high risk for cholecystectomy were recruited. We evaluated the technical and clinical success rates, adverse events rates, types of interventions through the stent and the patency profile. RESULTS From June 2017 to Oct 2018, a total of 53 patients received EUS-CDS (26) and EUS-GBD (27). The technical and clinical success rates were similar between the two groups (88.5% vs 88.9%, P = 1 and 88.5% vs 88.9%, P = 1 respectively). The differences in 30-day mortality rates [2 (7.7%) vs 2 (7.7%), P = 1] and adverse events [3 (11.5%) vs 3 (11.5%), P = 1] did not reach significance. Regarding long-term outcomes, two patients in each group suffered from adverse events (P = 1). One patient in the EUS-GBD group who was on direct oral anticoagulant suffered from stent induced bleeding. CONCLUSION The self-approximating LAMS with lower lumen apposing force was effective and safe with a low risk of buried stent syndrome and bleeding in the longer term. The ClinicalTrials.gov Identifier was NCT03002051.
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Affiliation(s)
- Anthony Yuen Bun Teoh
- Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Pradermchai Kongkam
- Division of Gastroenterology, Department of Medicine, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Amol Bapaye
- Department of Gastroenterology, Deenanath Mangeshkar Hospital, Pune, India
| | | | - Rungsun Reknimitr
- Division of Gastroenterology, Department of Medicine, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Sundeep Lakthakia
- Department of Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
| | - Shannon Melissa Chan
- Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Harshal P Gadhikar
- Department of Gastroenterology, Deenanath Mangeshkar Hospital, Pune, India
| | | | - Yun Nah Lee
- Department of Internal Medicine, SoonChunHyang University College of Medicine, Bucheon Hospital, Bucheon, Korea
| | - Jahangeer Medarapalem
- Department of Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
| | | | - Jong Ho Moon
- Department of Internal Medicine, SoonChunHyang University College of Medicine, Bucheon Hospital, Bucheon, Korea
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45
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Amato A, Sinagra E, Celsa C, Enea M, Buda A, Vieceli F, Scaramella L, Belletrutti P, Fugazza A, Cammà C, Radaelli F, Repici A, Anderloni A. Efficacy of lumen-apposing metal stents or self-expandable metal stents for endoscopic ultrasound-guided choledochoduodenostomy: a systematic review and meta-analysis. Endoscopy 2021; 53:1037-1047. [PMID: 33246343 DOI: 10.1055/a-1324-7919] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Endoscopic ultrasound (EUS)-guided biliary drainage is becoming an option for palliation of malignant biliary obstruction. Lumen-apposing metal stents (LAMS) are replacing self-expandable metal stents (SEMS). The aim of this meta-analysis was to evaluate the efficacy and safety of LAMS and SEMS for EUS-guided choledochoduodenostomy (EUS-CDS). METHODS A meta-analysis was performed using PRISMA protocols. Electronic databases were searched for studies on EUS-CDS. The primary outcome was clinical success. Secondary outcomes were technical success, reintervention, and adverse events. We used the random effects model with the DerSimonian-Laird estimation, and the results were depicted using forest plots. Subgroup analyses were also performed with data stratified by selected variable. RESULTS Overall, 31 studies (820 patients) were included. The pooled rates of clinical and technical success were 93.6 % (95 % confidence interval [CI] 88.6 %-96.5 %) and 94.8 % (95 %CI 90.2 %-97.3 %) for LAMS, and 91.7 % (95 %CI 88.1 %-94.2 %) and 92.7 % (95 %CI 89.9 %-94.9 %) for SEMS, respectively. The pooled rates of adverse events were 17.1 % (95 %CI 12.5 %-22.8 %) for LAMS and 18.3 % (95 %CI 14.3 %-23.0 %) for SEMS. The pooled rates of reintervention were 10.9 % (95 %CI 7.7 %-15.3 %) for LAMS and 13.9 % (95 %CI 9.6 %-19.7 %) for SEMS. Subgroup analyses confirmed these results. CONCLUSIONS This meta-analysis showed that LAMS and SEMS are comparable in terms of efficacy for EUS-CDS. Clinical and technical success, post-procedure adverse events, and reintervention rates were similar between LAMS and SEMS use; however, adverse events require further investigation.
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Affiliation(s)
- Arnaldo Amato
- Division of Digestive Endoscopy and Gastroenterology, Valduce Hospital, Como, Italy
| | - Emanuele Sinagra
- Gastroenterology and Endoscopy Unit, Fondazione Istituto G. Giglio, Cefalù, Italy
- Euro-Mediterranean Institute of Science and Technology (IEMEST), Section of Nutrition, Palermo, Italy
| | - Ciro Celsa
- Section of Gastroenterology and Hepatology, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, PROMISE, University of Palermo, Palermo, Italy
- Doctoral Programme in Experimental Oncology and Surgery, Department of Surgical Oncological and Oral Sciences, University of Palermo, Palermo, Italy
| | - Marco Enea
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, PROMISE, University of Palermo, Palermo, Italy
| | - Andrea Buda
- Gastroenterology Unit, Santa Maria del Prato Hospital, Feltre, Italy
| | - Filippo Vieceli
- Gastroenterology and Endoscopy Unit, Pancreas Center, University of Verona, Italy
| | - Lucia Scaramella
- Division of Digestive Endoscopy and Gastroenterology, Valduce Hospital, Como, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Italy
| | - Paul Belletrutti
- Humanitas University, Department of Biomedical Sciences, Milan, Italy
| | - Alessandro Fugazza
- Digestive Endoscopy Unit, Department of Gastroenterology, Humanitas Clinical and Research Center-IRCCS, Rozzano (MI), Italy
| | - Calogero Cammà
- Section of Gastroenterology and Hepatology, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, PROMISE, University of Palermo, Palermo, Italy
| | - Franco Radaelli
- Division of Digestive Endoscopy and Gastroenterology, Valduce Hospital, Como, Italy
| | - Alessandro Repici
- Humanitas University, Department of Biomedical Sciences, Milan, Italy
- Digestive Endoscopy Unit, Department of Gastroenterology, Humanitas Clinical and Research Center-IRCCS, Rozzano (MI), Italy
| | - Andrea Anderloni
- Digestive Endoscopy Unit, Department of Gastroenterology, Humanitas Clinical and Research Center-IRCCS, Rozzano (MI), Italy
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Kuraoka N, Hashimoto S, Matsui S, Terai S. Outcomes of Endoscopic Ultrasound-Guided Biliary Drainage in a General Hospital for Patients with Endoscopic Retrograde Cholangiopancreatography-Difficult Transpapillary Biliary Drainage. J Clin Med 2021; 10:jcm10184105. [PMID: 34575216 PMCID: PMC8471391 DOI: 10.3390/jcm10184105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 08/18/2021] [Accepted: 09/09/2021] [Indexed: 12/02/2022] Open
Abstract
Endoscopic ultrasound-guided biliary drainage (EUS-BD) has been developed as an alternative treatment for percutaneous transhepatic biliary drainage for patients with bile duct stenosis. At specialized hospitals, the high success rate and effectiveness of EUS-BD as primary drainage has been reported. However, the procedure is highly technical and difficult, and it has not been generally performed. In this study, we retrospectively examined the effectiveness of EUS-BD in ERCP-difficult patients with distal bile duct stenosis. We retrospectively examined 24 consecutive cases in which EUS-BD was performed at our hospital for distal bile duct stenosis from October 2018 to December 2020. EUS-guided choledochoduodenostomy (EUS-CDS) was selected for cases that could be approached from the duodenal bulb, and EUS-HGS was selected for other cases. In the EUS-CDS and EUS-HGS groups, the technical success rates were 83.3% (10/12] and 91.7% (11/12], respectively. An adverse event occurred in one case in the EUS-CDS group, which developed severe biliary peritonitis. The stent patency period was 91 and 101 days in the EUS-CDS and EUS-HGS groups, respectively. EUS-BD for ERCP-difficult patients with distal bile duct stenosis is considered to be an effective alternative for biliary drainage that can be performed not only in specialized hospitals but also in general hospitals.
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Affiliation(s)
- Naosuke Kuraoka
- Department of Gastroenterology, Saiseikai Kawaguchi General Hospital, 5-11-5 Nishikawaguchi, Kawaguchi, Saitama 332-8558, Japan; (S.H.); (S.M.)
- Correspondence: ; Tel.: +81-(48)-253-1551
| | - Satoru Hashimoto
- Department of Gastroenterology, Saiseikai Kawaguchi General Hospital, 5-11-5 Nishikawaguchi, Kawaguchi, Saitama 332-8558, Japan; (S.H.); (S.M.)
| | - Shigeru Matsui
- Department of Gastroenterology, Saiseikai Kawaguchi General Hospital, 5-11-5 Nishikawaguchi, Kawaguchi, Saitama 332-8558, Japan; (S.H.); (S.M.)
| | - Shuji Terai
- Department of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, 1-757 Asahimachidori, Niigata 951-8510, Japan;
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47
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Biliary Drainage With Endoscopic Ultrasound-Guided Choledochoenterostomy in a Patient With Duodenal Switch Anatomy. ACG Case Rep J 2021; 8:e00648. [PMID: 34476275 PMCID: PMC8386907 DOI: 10.14309/crj.0000000000000648] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 04/13/2021] [Indexed: 11/17/2022] Open
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Law RJ, Chandrasekhara V, Bhatt A, Bucobo JC, Copland AP, Krishnan K, Kumta NA, Pannala R, Parsi MA, Rahimi EF, Saumoy M, Trikudanathan G, Trindade AJ, Yang J, Lichtenstein DR. Lumen-apposing metal stents (with videos). Gastrointest Endosc 2021; 94:457-470. [PMID: 34311975 DOI: 10.1016/j.gie.2021.05.020] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 05/12/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Lumen-apposing metal stents (LAMSs) are a novel class of devices that have expanded the spectrum of endoscopic GI interventions. LAMSs with their dumbbell configuration, short saddle length, and large inner luminal diameter provide favorable stent characteristics to facilitate anastomosis formation between the gut lumen and adjacent structures. METHODS The MEDLINE database was searched through April 2021 for articles related to LAMSs by using additional relevant keywords such as "walled-off pancreatic necrosis," "pseudocysts," "pancreatic fluid collection," "cholecystitis," "gastroenterostomy," in addition to "endoscopic treatment" and "endoscopic management," among others. RESULTS This technology review describes the full spectrum of LAMS designs and delivery systems, techniques for deployment, procedural outcomes, safety, training issues, and financial considerations. CONCLUSIONS Although LAMSs were initially introduced for drainage of pancreatic pseudocysts and walled-off necrosis, the versatility of these devices has led to a variety of off-label uses including gallbladder drainage, enteric bypass with the creation of gastroenterostomies, and treatment of luminal GI strictures.
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Affiliation(s)
- Ryan J Law
- Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Vinay Chandrasekhara
- Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Amit Bhatt
- Department of Gastroenterology, Hepatology & Nutrition, Cleveland Clinic, Cleveland, Ohio, USA
| | - Juan Carlos Bucobo
- Division of Gastroenterology and Hepatology, Stony Brook Medicine, Stony Brook, New York, USA
| | - Andrew P Copland
- Division of Gastroenterology and Hepatology, University of Virginia Health Systems, Charlottesville, Virginia, USA
| | - Kumar Krishnan
- Division of Gastroenterology, Department of Internal Medicine, Harvard Medical School and Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Nikhil A Kumta
- Division of Gastroenterology, Mount Sinai Hospital, New York, New York, USA
| | - Rahul Pannala
- Department of Gastroenterology and Hepatology, Mayo Clinic, Scottsdale, Arizona, USA
| | - Mansour A Parsi
- Section for Gastroenterology and Hepatology, Tulane University Health Sciences Center, New Orleans, Louisiana, USA
| | - Erik F Rahimi
- Department of Gastroenterology, Baylor Scott & White Health, Lakeway, Texas, USA
| | - Monica Saumoy
- Department of Gastroenterology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Guru Trikudanathan
- Division of Gastroenterology, Hepatology and Nutrition, University of Minnesota, Minneapolis, Minnesota, USA
| | - Arvind J Trindade
- Department of Gastroenterology, Zucker School of Medicine at Hofstra/Northwell, Long Island Jewish Medical Center, New Hyde Park, New York, USA
| | - Julie Yang
- Division of Gastroenterology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - David R Lichtenstein
- Division of Gastroenterology, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA
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Yoo HW, Moon JH, Jo SJ, Lee YN, Park JK, Lee TH, Cha SW, Cho YD, Park SH, Park SI, Jeong S, Lee DH. A novel electrocautery-enhanced delivery system for one-step endoscopic ultrasound-guided drainage of the gallbladder and bile duct using a lumen-apposing metal stent: a feasibility study. Endoscopy 2021; 53:922-926. [PMID: 33336343 DOI: 10.1055/a-1301-1526] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND The use of a lumen-apposing metal stent (LAMS) capable of one-step endoscopic ultrasound-guided transmural drainage (EUS-TD) can increase the effectiveness of the procedure. We evaluated the newly developed electrocautery-enhanced (EC) delivery system with a LAMS for one-step EUS-guided gallbladder drainage (EUS-GBD) or choledochoduodenostomy (EUS-CDS). METHODS In the animal experiment, an EC-LAMS was advanced into the gallbladder without prior tract dilation in four pigs. A conventional LAMS was inserted in another four pigs as a control group. After the animal experiment, 17 patients underwent EUS-TD using the EC-LAMS (EUS-GBD in 10 patients, EUS-CDS in 7). The primary outcome was the technical success rate. RESULTS In the animal study, the mean procedure time was significantly shorter in the EC-LAMS group than in the conventional LAMS group. In the human study, the overall technical success rate was 94.1 %, with one EUS-GBD failure. The clinical success rate was 100 %. The overall adverse event rate was 17.6 %. CONCLUSIONS One-step EUS-GBD or EUS-CDS using the novel EC-LAMS is a feasible approach that achieves a high success rate and maintains safety.
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Affiliation(s)
- Hae Won Yoo
- Digestive Disease Center and Research Institute, Department of Internal Medicine, SoonChunHyang University School of Medicine, Bucheon, Republic of Korea
| | - Jong Ho Moon
- Digestive Disease Center and Research Institute, Department of Internal Medicine, SoonChunHyang University School of Medicine, Bucheon, Republic of Korea
| | - Seok Jung Jo
- Digestive Disease Center and Research Institute, Department of Internal Medicine, SoonChunHyang University School of Medicine, Bucheon, Republic of Korea
| | - Yun Nah Lee
- Digestive Disease Center and Research Institute, Department of Internal Medicine, SoonChunHyang University School of Medicine, Bucheon, Republic of Korea
| | - Jae Keun Park
- Digestive Disease Center and Research Institute, Department of Internal Medicine, SoonChunHyang University School of Medicine, Bucheon, Republic of Korea
| | - Tae Hoon Lee
- Digestive Disease Center and Research Institute, Department of Internal Medicine, SoonChunHyang University School of Medicine, Cheonan, Republic of Korea
| | - Sang-Woo Cha
- Digestive Disease Center and Research Institute, Department of Internal Medicine, SoonChunHyang University School of Medicine, Seoul, Republic of Korea
| | - Young Deok Cho
- Digestive Disease Center and Research Institute, Department of Internal Medicine, SoonChunHyang University School of Medicine, Seoul, Republic of Korea
| | - Sang-Heum Park
- Digestive Disease Center and Research Institute, Department of Internal Medicine, SoonChunHyang University School of Medicine, Cheonan, Republic of Korea
| | - Se Ik Park
- Department of Research and Development, Taewoong Medical, Ilsan, Republic of Korea
| | - Seok Jeong
- Digestive Disease Center and Research Institute, Department of Internal Medicine, Inha University College of Medicine, Incheon, Korea
| | - Don Haeng Lee
- Digestive Disease Center and Research Institute, Department of Internal Medicine, Inha University College of Medicine, Incheon, Korea
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50
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Pawa R, Pleasant T, Tom C, Pawa S. Endoscopic ultrasound-guided biliary drainage: Are we there yet? World J Gastrointest Endosc 2021; 13:302-318. [PMID: 34512878 PMCID: PMC8394188 DOI: 10.4253/wjge.v13.i8.302] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 05/14/2021] [Accepted: 07/14/2021] [Indexed: 02/06/2023] Open
Abstract
Endoscopic retrograde cholangiopancreatography (ERCP) is the mainstay procedure of choice for management of obstructive biliary disease. While ERCP is widely performed with high success rates, the procedure is not feasible in every patient such as cases of non-accessible papilla. In the setting of unsuccessful ERCP, endoscopic ultrasound-guided biliary drainage (EUS-BD) has become a promising alternative to surgical bypass and percutaneous biliary drainage (PTBD). A variety of different forms of EUS-BD have been described, allowing for both intrahepatic and extrahepatic approaches. Recent studies have reported high success rates utilizing EUS-BD for both transpapillary and transluminal drainage, with fewer adverse events when compared to PTBD. Advancements in novel technologies designed specifically for EUS-BD have led to increased success rates as well as improved safety profile for the procedure. The techniques of EUS-BD are yet to be fully standardized and are currently performed by highly trained advanced endoscopists. The aim of our review is to highlight the different EUS-guided interventions for achieving biliary drainage and to both assess the progress that has been made in the field as well as consider what the future may hold.
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Affiliation(s)
- Rishi Pawa
- Department of Internal Medicine, Section of Gastroenterology and Hepatology, Wake Forest Baptist Medical Center, Winston-Salem, NC 27157, United States
| | - Troy Pleasant
- Department of Internal Medicine, Section of Gastroenterology and Hepatology, Wake Forest Baptist Medical Center, Winston-Salem, NC 27157, United States
| | - Chloe Tom
- Department of Medicine, Wake Forest School of Medicine, Winston-Salem, NC 27101, United States
| | - Swati Pawa
- Department of Internal Medicine, Section of Gastroenterology and Hepatology, Wake Forest Baptist Medical Center, Winston-Salem, NC 27157, United States
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