Common bile duct size in malignant distal obstruction and lumen-apposing metal stents: a multicenter prospective study

Mihai Rimbaş; Andrea Anderloni; Bertrand Napoléon; Andrada Seicean; Edoardo Forti; Stefano Francesco Crinò; Ilaria Tarantino; Paolo Giorgio Arcidiacono; Carlo Fabbri; Gianenrico Rizzatti; Arnaldo Amato; Theodor Voiosu; Alessandro Fugazza; Ofelia Moșteanu; Àngels Ginès; Germana de Nucci; Pietro Fusaroli; Nam Quoc Nguyen; Roberto Di Mitri; Leonardo Minelli Grazioli; Massimiliano Mutignani; Livia Archibugi; Cecilia Binda; Anna Cominardi; Carmelo Barbera; Glòria Fernández-Esparrach; Laurent Palazzo; Maxime Palazzo; Jan Werner Poley; Cristiano Spada; Giorgio Valerii; Takao Itoi; Yukitoshi Matsunami; Radu Bogdan Mateescu; Cristian Băicuș; Guido Costamagna; Alberto Larghi

doi:10.1055/a-1526-1208

Endoscopy International Open, Inhaltsverzeichnis

CC BY-NC-ND 4.0 · Endosc Int Open 2021; 09(11): E1801-E1810
DOI: 10.1055/a-1526-1208

Original article

Common bile duct size in malignant distal obstruction and lumen-apposing metal stents: a multicenter prospective study

Mihai Rimbaş

¹Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy

³Department of Internal Medicine, Carol Davila University of Medicine, Bucharest, Romania

,

Andrea Anderloni

⁴Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Clinical and Research Center, IRCCS, Rozzano, Milan, Italy

,

Bertrand Napoléon

⁵Endoscopy Unit, Jean Mermoz Private Hospital, Ramsay Generale de Santé, Lyon, France

,

Andrada Seicean

⁶Department of Gastroenterology, Regional Institute of Gastroenterology and Hepatology, Iuliu Haţieganu University of Medicine, Cluj-Napoca, Romania

,

Edoardo Forti

⁷Digestive Endoscopy Unit, Grande Ospedale Metropolitano Niguarda, Milan, Italy

,

Stefano Francesco Crinò

⁸Gastroenterology and Digestive Endoscopy Unit, The Pancreas Institute, G.B. Rossi University Hospital, Verona, Italy

,

Ilaria Tarantino

⁹Endoscopy Service, Department of Diagnostic and Therapeutic Services, Istituto Mediterraneo per i Trapianti e Terapie ad alta Specializzazione, Palermo, Italy

,

Paolo Giorgio Arcidiacono

¹⁰Pancreato-Biliary Endoscopy and Endosonography Division, Pancreas Translational & Clinical Research Center, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy

,

Carlo Fabbri

¹¹Gastroenterology and Digestive Endoscopy Unit, Forlì-Cesena Hospitals, AUSL Romagna, Italy

,

Gianenrico Rizzatti

¹Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy

¹²CERTT, Center for Endoscopic Research Therapeutics and Training, Catholic University, Rome, Italy

,

Arnaldo Amato

¹³Gastroenterology Division, Valduce Hospital, Como, Italy

,

Theodor Voiosu

²Gastroenterology Department, Colentina Clinical Hospital, Bucharest, Romania

³Department of Internal Medicine, Carol Davila University of Medicine, Bucharest, Romania

,

Alessandro Fugazza

⁴Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Clinical and Research Center, IRCCS, Rozzano, Milan, Italy

,

Ofelia Moșteanu

⁶Department of Gastroenterology, Regional Institute of Gastroenterology and Hepatology, Iuliu Haţieganu University of Medicine, Cluj-Napoca, Romania

,

Àngels Ginès

¹⁴Endoscopy Unit, Institut de Malalties Digestives i Metabòliques, Hospital Clínic, University of Barcelona, IDIBAPS, CIBEREHD, Barcelona, Spain

,

Germana de Nucci

¹⁵Gastroenterology Unit, ASST Rhodense, Garbagnate Milanese, Italy

,

Pietro Fusaroli

¹⁶Gastroenterology Unit, Hospital of Imola, Department of Medical and Surgical Sciences, University of Bologna, Italy

,

Nam Quoc Nguyen

¹⁷Department of Gastroenterology, Royal Adelaide Hospital, Adelaide, Australia

,

Roberto Di Mitri

¹⁸Gastroenterology and Endoscopy Unit, ARNAS Civico – Di Cristina – Benfratelli, Palermo, Italy

,

Leonardo Minelli Grazioli

¹⁹Digestive Endoscopy Unit and Gastroenterology, Fondazione Poliambulanza, Brescia, Italia

,

Massimiliano Mutignani

⁷Digestive Endoscopy Unit, Grande Ospedale Metropolitano Niguarda, Milan, Italy

,

Livia Archibugi

¹⁰Pancreato-Biliary Endoscopy and Endosonography Division, Pancreas Translational & Clinical Research Center, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy

,

Cecilia Binda

¹¹Gastroenterology and Digestive Endoscopy Unit, Forlì-Cesena Hospitals, AUSL Romagna, Italy

,

Anna Cominardi

¹⁶Gastroenterology Unit, Hospital of Imola, Department of Medical and Surgical Sciences, University of Bologna, Italy

,

Carmelo Barbera

²⁰U.O.C. di Gastroenterologia ed Endoscopia Digestiva, Ospedale Giuseppe Mazzini, ASL Teramo, Italy

,

Glòria Fernández-Esparrach

¹⁴Endoscopy Unit, Institut de Malalties Digestives i Metabòliques, Hospital Clínic, University of Barcelona, IDIBAPS, CIBEREHD, Barcelona, Spain

,

Laurent Palazzo

²¹Department of Endoscopy, Trocadero Clinic, Paris, France

,

Maxime Palazzo

²²Digestive Endoscopy Unit, Beaujon University Hospital, Clichy-la-Garenne, France

,

Jan Werner Poley

²³Department of Gastroenterology and Hepatology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands

,

Cristiano Spada

¹Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy

¹⁹Digestive Endoscopy Unit and Gastroenterology, Fondazione Poliambulanza, Brescia, Italia

,

Giorgio Valerii

²⁰U.O.C. di Gastroenterologia ed Endoscopia Digestiva, Ospedale Giuseppe Mazzini, ASL Teramo, Italy

,

Takao Itoi

²⁴Department of Gastroenterology and Hepatology, Tokyo Medical University Hospital, Tokyo, Japan

,

Yukitoshi Matsunami

²⁴Department of Gastroenterology and Hepatology, Tokyo Medical University Hospital, Tokyo, Japan

,

Radu Bogdan Mateescu

²Gastroenterology Department, Colentina Clinical Hospital, Bucharest, Romania

³Department of Internal Medicine, Carol Davila University of Medicine, Bucharest, Romania

,

Cristian Băicuș

³Department of Internal Medicine, Carol Davila University of Medicine, Bucharest, Romania

,

Guido Costamagna

¹Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy

¹²CERTT, Center for Endoscopic Research Therapeutics and Training, Catholic University, Rome, Italy

,

Alberto Larghi

¹Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy

¹²CERTT, Center for Endoscopic Research Therapeutics and Training, Catholic University, Rome, Italy

› Institutsangaben

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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Referenzen

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