Albert Garcia-Sumalla1, Carme Loras2,3, Carlos Guarner-Argente4,3, Julio G Velasquez-Rodriguez1, Xavier Andujar2, Silvia Salord1, Juli Busquets5, Cristian Tebe6, Berta Laquente7, Joan B Gornals8,9. 1. Endoscopy Unit, Department of Digestive Diseases, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), University of Barcelona, Barcelona, Catalonia, Spain. 2. Endoscopy Unit, Department of Digestive Diseases, Hospital Universitari Mútua Terrassa, Fundació per la Recerca Mútua Terrassa, CIBERehd, Terrassa, Spain. 3. Faculty of Health Sciences, Universitat Oberta de Catalunya, Barcelona, Catalonia, Spain. 4. Endoscopy Unit, Department of Digestive Diseases, Hospital Sant Pau i Santa Creu, Barcelona, Catalonia, Spain. 5. Department of Surgery, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), University of Barcelona, Barcelona, Catalonia, Spain. 6. Biostatistics Unit, Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain. 7. Department of Medical Oncology, Institut Català d'Oncologia DiR, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet, Barcelona, Spain. 8. Endoscopy Unit, Department of Digestive Diseases, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), University of Barcelona, Barcelona, Catalonia, Spain. jgornals@bellvitgehospital.cat. 9. Faculty of Health Sciences, Universitat Oberta de Catalunya, Barcelona, Catalonia, Spain. jgornals@bellvitgehospital.cat.
Abstract
BACKGROUND: There are uncertainties concerning the possible benefits derived from the insertion of double-pigtail plastic stents (DPS) within lumen-apposing metal stents (LAMS) in EUS-guided choledochoduodenostomy (CDS). The aim of this study was to determine whether a DPS within a biliary LAMS offers a potential benefit in EUS-guided CDS for the palliative management of malignant biliary obstruction. METHODS: This was a multicentre retrospective study at three tertiary institutions. PERIOD: May 2015 to August 2020. Two interventional strategies (LAMS alone and LAMS plus DPS) were compared. The choice was the endoscopist's discretion. Inclusion: unresectable/inoperable biliopancreatic tumours with previous failed ERCP. Clinical success: bilirubin decrease > 30% at 4 weeks. RESULTS: Forty-one consecutive cases of EUS-CDS using biliary LAMS were treated (22 women; mean age, 72.3 years) during the study period. The procedure was technically successful in 39 (95.1%), who were managed using the two strategies (22 LAMS alone; 17 LAMS plus DPS). No differences between the groups, in terms of clinical success (77.3 vs 87.5%, p = 0.67), adverse events (AEs, 13.6 vs 11.8%, p = 0.99), recurrent biliary obstruction (RBO, 13.6 vs 23.5%, p = 0.67), or survival rate (p = 0.67) were encountered. The LAMS alone group had a shorter length of procedure (50 min vs 66 min, p = 0.102). No risk factors related to clinical success, AEs, RBO, or survival were detected. CONCLUSIONS: The technical variant of adding a coaxial DPS within LAMS in EUS-CDS seems not to be enough to prevent biliary morbidities, and it is a time-consuming strategy. Although prospective studies are needed, these results do not support its routine use.
BACKGROUND: There are uncertainties concerning the possible benefits derived from the insertion of double-pigtail plastic stents (DPS) within lumen-apposing metal stents (LAMS) in EUS-guided choledochoduodenostomy (CDS). The aim of this study was to determine whether a DPS within a biliary LAMS offers a potential benefit in EUS-guided CDS for the palliative management of malignant biliary obstruction. METHODS: This was a multicentre retrospective study at three tertiary institutions. PERIOD: May 2015 to August 2020. Two interventional strategies (LAMS alone and LAMS plus DPS) were compared. The choice was the endoscopist's discretion. Inclusion: unresectable/inoperable biliopancreatic tumours with previous failed ERCP. Clinical success: bilirubin decrease > 30% at 4 weeks. RESULTS: Forty-one consecutive cases of EUS-CDS using biliary LAMS were treated (22 women; mean age, 72.3 years) during the study period. The procedure was technically successful in 39 (95.1%), who were managed using the two strategies (22 LAMS alone; 17 LAMS plus DPS). No differences between the groups, in terms of clinical success (77.3 vs 87.5%, p = 0.67), adverse events (AEs, 13.6 vs 11.8%, p = 0.99), recurrent biliary obstruction (RBO, 13.6 vs 23.5%, p = 0.67), or survival rate (p = 0.67) were encountered. The LAMS alone group had a shorter length of procedure (50 min vs 66 min, p = 0.102). No risk factors related to clinical success, AEs, RBO, or survival were detected. CONCLUSIONS: The technical variant of adding a coaxial DPS within LAMS in EUS-CDS seems not to be enough to prevent biliary morbidities, and it is a time-consuming strategy. Although prospective studies are needed, these results do not support its routine use.
Authors: Yen-I Chen; Kashi Callichurn; Avijit Chatterjee; Etienne Desilets; Donnellan Fergal; Nauzer Forbes; Ian Gan; Sana Kenshil; Mouen A Khashab; Rastislav Kunda; Eric Lam; Gary May; Rachid Mohamed; Jeff Mosko; Sarto C Paquin; Anand Sahai; Gurpal Sandha; Christopher Teshima; Alan Barkun; Jeffrey Barkun; Ali Bessissow; Kristina Candido; Myriam Martel; Corey Miller; Kevin Waschke; George Zogopoulos; Clarence Wong Journal: Trials Date: 2019-12-09 Impact factor: 2.279
Authors: Albert Garcia-Sumalla; Carme Loras; Vicente Sanchiz; Rafael Pedraza Sanz; Enrique Vazquez-Sequeiros; Jose Ramon Aparicio; Carlos de la Serna-Higuera; Daniel Luna-Rodriguez; Xavier Andujar; María Capilla; Tatiana Barberá; Jose Ramon Foruny-Olcina; Belen Martínez; Miguel Dura; Silvia Salord; Berta Laquente; Cristian Tebe; Sebastia Videla; Manuel Perez-Miranda; Joan B Gornals Journal: Trials Date: 2022-02-25 Impact factor: 2.728