BACKGROUND AND AIMS: EUS-guided choledochoduodenostomy (EUS-CD) using a lumen-apposing metal stent (LAMS) has recently been reported as an alternative treatment approach for patients with malignant obstructive jaundice and failed ERCP. We analyzed the safety and technical and clinical efficacy of EUS-CD using LAMSs in patients with malignant obstructive jaundice. METHODS: This was a retrospective study of consecutive patients with inoperable malignant distal bile duct obstruction who underwent EUS-CD using an electrocautery-enhanced (EC)-LAMS over a 3-year period (2015-2018). The main outcome measures were technical and clinical success (defined as a decline in serum bilirubin level by 50% at 2-week follow-up). Secondary outcomes were occurrence of adverse events, procedure time, and stent patency. RESULTS: Forty-six patients (47.8% women; median age, 73.1 ± 12.6 years) underwent direct EUS-CD using the biliary EC-LAMS. The procedure was technically successful in 43 patients (93.5%). The rate of clinical success was 97.7%. Adverse events occurred in 5 (11.6%) patients and included the following: 1 fatal bleeding 17 days after stent placement, 3 episodes of stent occlusion (food impaction), and 1 spontaneous migration (all 4 requiring reintervention). The mean follow-up was 114.37 days (95% confidence interval, 73.2-155.4). CONCLUSIONS: EUS-CD using the EC-LAMS is effective. The rate of adverse events including one fatal event is not negligible and should be carefully considered before using the stent in this clinical setting. Prospective studies are required to validate our preliminary findings to fully assess the long-term efficacy and safety of the stent.
BACKGROUND AND AIMS: EUS-guided choledochoduodenostomy (EUS-CD) using a lumen-apposing metal stent (LAMS) has recently been reported as an alternative treatment approach for patients with malignant obstructive jaundice and failed ERCP. We analyzed the safety and technical and clinical efficacy of EUS-CD using LAMSs in patients with malignant obstructive jaundice. METHODS: This was a retrospective study of consecutive patients with inoperable malignant distal bile duct obstruction who underwent EUS-CD using an electrocautery-enhanced (EC)-LAMS over a 3-year period (2015-2018). The main outcome measures were technical and clinical success (defined as a decline in serum bilirubin level by 50% at 2-week follow-up). Secondary outcomes were occurrence of adverse events, procedure time, and stent patency. RESULTS: Forty-six patients (47.8% women; median age, 73.1 ± 12.6 years) underwent direct EUS-CD using the biliary EC-LAMS. The procedure was technically successful in 43 patients (93.5%). The rate of clinical success was 97.7%. Adverse events occurred in 5 (11.6%) patients and included the following: 1 fatal bleeding 17 days after stent placement, 3 episodes of stent occlusion (food impaction), and 1 spontaneous migration (all 4 requiring reintervention). The mean follow-up was 114.37 days (95% confidence interval, 73.2-155.4). CONCLUSIONS:EUS-CD using the EC-LAMS is effective. The rate of adverse events including one fatal event is not negligible and should be carefully considered before using the stent in this clinical setting. Prospective studies are required to validate our preliminary findings to fully assess the long-term efficacy and safety of the stent.
Authors: Abdul H El Chafic; Janak N Shah; Chris Hamerski; Kenneth F Binmoeller; Shayan Irani; Theodore W James; Todd H Baron; Jose Nieto; Ricardo V Romero; John A Evans; Michel Kahaleh Journal: Dig Dis Sci Date: 2019-06-07 Impact factor: 3.199
Authors: Nuno Nunes; Margarida Flor de Lima; Ana Caldeira; Sílvia Leite; Susana Marques; Teresa Moreira; Pedro Moutinho-Ribeiro; Miguel Bispo Journal: GE Port J Gastroenterol Date: 2020-09-25
Authors: Benedetto Mangiavillano; Jong Ho Moon; Antonio Facciorusso; Francesco Di Matteo; Danilo Paduano; Milutin Bulajic; Andrew Ofosu; Francesco Auriemma; Laura Lamonaca; Hae Won Yoo; Roberta Rea; Marco Massidda; Alessandro Repici Journal: Endosc Int Open Date: 2022-07-15
Authors: Marina de Benito Sanz; Rodrigo Nájera-Muñoz; Carlos de la Serna-Higuera; Esteban Fuentes-Valenzuela; Ignacio Fanjul; Carlos Chavarría; Francisco Javier García-Alonso; Ramón Sanchez-Ocana; Ana Yaiza Carbajo; Sergio Bazaga; Manuel Perez-Miranda Journal: Surg Endosc Date: 2020-11-30 Impact factor: 4.584