Wei On1, Bharat Paranandi1, Andrew M Smith1, Suresh V Venkatachalapathy2, Martin W James2, Guruprasad P Aithal3, Ioannis Varbobitis2, Danny Cheriyan4, Ciaran McDonald4, John S Leeds5, Manu K Nayar6, Kofi W Oppong6, Joe Geraghty7, John Devlin8, Wafaa Ahmed8, Ryan Scott9, Terence Wong10, Matthew T Huggett1. 1. Department of Gastroenterology, Leeds Teaching Hospitals NHS Trust, Leeds, UK. 2. Department of Gastroenterology, NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust, University of Nottingham, Nottingham, UK. 3. Department of Gastroenterology, NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust, University of Nottingham, Nottingham, UK; Nottingham Digestive Diseases Centre, School of Medicine, University of Nottingham, Nottingham, UK. 4. Beaumont Hospital and RCSI, Dublin, Ireland. 5. Department of Gastroenterology, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK; Population Health Sciences Institute, Newcastle University, Newcastle, UK. 6. Department of Gastroenterology, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK. 7. Department of Gastroenterology, Manchester University NHS Foundation Trust, Manchester, UK. 8. Department of Gastroenterology, King's College Hospital NHS Foundation Trust, London, London, UK. 9. Department of Gastroenterology, Belfast Health and Social Care Trust, Belfast, Ireland. 10. Department of Gastroenterology, Guys' and St Thomas' NHS Foundation Trust, London, UK.
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. Crown
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. Crown
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: 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