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

Abstract

Background and study aims There is increasing evidence to suggest that EUS-guided biliary drainage (EUS-BD) is a safe and effective treatment alternative for patients with malignant biliary obstructions (MBOs) after failed endoscopic retrograde cholangiopancreatography.

Patients and methods We performed a retrospective analysis of data prospectively collected from patients with MBO who underwent choledochoduodenostomy (CDS) or gallbladder drainage (GBD) between August 2016 and June 2020 using the electrocautery-enabled lumen-apposing metal stents (ECE-LAMS). The primary endpoint was technical and clinical success. Secondary endpoints were adverse events (AEs) and reinterventions.

Results A total of 60 patients were included in the study, with 56 CDS and 4 GBD. Median age was 76 years with 57 % male (34/60). The most common indication for EUS-BD was pancreatic cancer (78 %). Technical success was achieved in 100 % of cases, with a clinical success rate of 91.7 %. Mean total bilirubin pre-procedure was 202 umol/L (normal < 20 umol/L) and 63.8 umol/L post procedure (P < .001). Twenty-one patients had bilirubin recorded at 2 weeks post EUS-BD with 20 of 21 patients demonstrating > 50 % reduction in bilirubin (mean bilirubin reduction 75 %). AEs occurred in 12 of 60 patients (20 %), all of which were mild. The reintervention rate was 11.7 % (7/60). Stent occlusion occurred in 10 of 60 patients (16.7 %) with a mean time to stent occlusion of 46.2 days (3–133). Stent patency of 83.3 % was observed with a mean follow up of 7.9 months.

Conclusion EUS-CDS and GBD using ECE-LAMS are effective EUS-based techniques for managing patients with MBO. AEs are usually mild and resolved by reintervention.

Publikationsverlauf

Eingereicht: 09. Mai 2020

Angenommen: 15. Juli 2020

Artikel online veröffentlicht:
22. Oktober 2020

• References

• 1 Sassatelli R, Cecinato P, Lupo M. et al. Endoscopic ultrasound-guided biliary drainage for malignant biliary obstruction after failed ERCP in low performance status patients. Dig Liver Dis 2020; 52: 57-63
• 2 Zhao X-q, Dong J-h, Jiang K. et al. PTBD vs EBD for biliary obstruction. Digestive Endoscopy 2015; 27: 137-145
• 3 Nennstiel S, Weber A, Frick G. et al. Drainage-related complications in percutaneous transhepatic biliary drainage: An analysis over 10 years. J Clin Gastroenterol 2015; 49: 764-770
• 4 Nam K, Kim DU, Lee TH. et al. Patient perception and preference of EUS-guided drainage over percutaneous drainage when endoscopic transpapillary biliary drainage fails: An international multicenter survey. Endosc Ultrasound 2018; 7: 48-55
• 5 Artifon EL, Sakai P, Cunha JE. et al. Surgery or endoscopy for palliation of biliary obstruction due to metastatic pancreatic cancer. Am J Gastroenterol 2006; 101: 2031-2037
• 6 Bliss LA, Eskander MF, Kent TS. et al. Early surgical bypass versus endoscopic stent placement in pancreatic cancer. HPB (Oxford) 2016; 18: 671-677
• 7 Giovannini M, Moutardier V, Pesenti C. et al. Endoscopic ultrasound-guided bilioduodenal anastomosis: A new technique for biliary drainage. Endoscopy 2001; 33: 898-900
• 8 Itoi T, Binmoeller KF. EUS-guided choledochoduodenostomy by using a biflanged lumen-apposing metal stent. Gastrointest Endosc 2014; 79: 715
• 9 Anderloni A, Fugazza A, Troncone E. et al. Single-stage EUS-guided choledochoduodenostomy using a lumen-apposing metal stent for malignant distal biliary obstruction. Gastrointest Endosc 2019; 89: 69-76
• 10 Jacques J, Privat J, Pinard F. et al. Endoscopic ultrasound-guided choledochoduodenostomy with electrocautery-enhanced lumen-apposing stents: A retrospective analysis. Endoscopy 2019; 51: 540-547
• 11 Tsuchiya T, Teoh AYB, Itoi T. et al. Long-term outcomes of EUS-guided choledochoduodenostomy using a lumen-apposing metal stent for malignant distal biliary obstruction: A prospective multicenter study. Gastrointest Endosc 2018; 87: 1138-1146
• 12 Sharaiha RZ, Khan MA, Kamal F. et al. Efficacy and safety of EUS-guided biliary drainage in comparison with percutaneous biliary drainage when ERCP fails: a systematic review and meta-analysis. Gastrointest Endosc 2017; 85: 904-914
• 13 Han SY, Kim S, So H. et al. EUS-guided biliary drainage versus ERCP for first-line palliation of malignant distal biliary obstruction: A systematic review and meta-analysis. Sci Rep 2019; 9: 16551
• 14 Miller CS, Barkun AN, Martel M. et al. Endoscopic ultrasound-guided biliary drainage for distal malignant obstruction: a systematic review and meta-analysis of randomized trials. Endosc Int Open 2019; 7: E1563-E1573
• 15 Paik WH, Lee TH, Park DH. et al. EUS-guided biliary drainage versus ercp for the primary palliation of malignant biliary obstruction: a multicenter randomized clinical trial. Am J Gastroenterol 2018; 113: 987-997
• 16 Imai H, Kitano M, Omoto S. et al. EUS-guided gallbladder drainage for rescue treatment of malignant distal biliary obstruction after unsuccessful ERCP. Gastrointest Endosc 2016; 84: 147-151
• 17 Khan MA, Akbar A, Baron TH. et al. Endoscopic ultrasound-guided biliary drainage: a systematic review and meta-analysis. Dig Dis Sci 2016; 61: 684-703
• 18 Wang K, Zhu J, Xing L. et al. Assessment of efficacy and safety of EUS-guided biliary drainage: A systematic review. Gastrointest Endosc 2016; 83: 1218-1227
• 19 Kadaba R, Bowers K, Khorsandi S. et al. Complications of biliary-enteric anastomoses. Ann R Coll Surg Eng 2017; 99: 210-215
• 20 Sawas T, Al Halabi S, Parsi MA. et al. Self-expandable metal stents versus plastic stents for malignant biliary obstruction: a meta-analysis. Gastrointest Endosc 2015; 82: 256-267.e7
• 21 Staub J, Siddiqui A, Taylor L. et al. ERCP performed through previously placed duodenal stents: a multicenter retrospective study of outcomes and adverse events. Gastrointest Endosc 2018; 87: 1499-1504
• 22 Lee JJ, Hyun JJ, Choe JW. et al. Endoscopic biliary stent insertion through specialized duodenal stent for combined malignant biliary and duodenal obstruction facilitated by stent or PTBD guidance. Scand J Gastroenterol 2017; 52: 1258-1262
• 23 Mutignani M, Tringali A, Shah SG. et al. Combined endoscopic stent insertion in malignant biliary and duodenal obstruction. Endoscopy 2007; 39: 440-447
• 24 El Chafic AH, Shah JN, Hamerski C. et al. EUS-guided choledochoduodenostomy for distal malignant biliary obstruction using electrocautery-enhanced lumen-apposing metal stents: first US, multicenter experience. Digest Dis Sci 2019; 64: 3321-3327
• 25 Khashab MA, Valeshabad AK, Leung W. et al. Multicenter experience with performance of ERCP in patients with an indwelling duodenal stent. Endoscopy 2014; 46: 252-255
• 26 Anderloni A, Buda A, Carrara S. et al. Single-session double-stent placement in concomitant malignant biliary and duodenal obstruction with a cautery-tipped lumen apposing metal stent. Endoscopy 2016; 48: E321-E322
• 27 Anderloni A, Fugazza A, Auriemma F. et al. Cautery-tipped lumen apposing metal stent placement through the mesh of an indwelling duodenal self-expanding metal stent. Am J Gastroenterol 2018; 113: 644
• 28 Fabbri C, Fugazza A, Binda C. et al. Beyond palliation: using EUS-guided choledochoduodenostomy with a lumen-apposing metal stent as a bridge to surgery. J Gastrointest Liver Dis 2019; 51: e126
• 29 Jacques J, Privat J, Pinard F. et al. EUS-guided choledochoduodenostomy using electrocautery enhanced lumen-apposing metal stents: a French multicenter study after implementation of the technique (with video). Gastrointest Endosc 2020; 92: 134-141