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CC BY 4.0 · Endoscopy 2024; 56(01): 47-52
DOI: 10.1055/a-2134-3537
Innovations and brief communications

Endoscopic ultrasound-guided choledochoduodenostomy using single-step lumen-apposing metal stents for primary drainage of malignant distal biliary obstruction (SCORPION-p): a prospective pilot study

Jeska A. Fritzsche
1   Department of Gastroenterology and Hepatology, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands
2   Amsterdam Gastroenterology Endocrinology Metabolism, Research Institute, Amsterdam, The Netherlands
3   Treatment and Quality of life, Cancer Center Amsterdam, Amsterdam, The Netherlands
,
Paul Fockens
1   Department of Gastroenterology and Hepatology, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands
2   Amsterdam Gastroenterology Endocrinology Metabolism, Research Institute, Amsterdam, The Netherlands
3   Treatment and Quality of life, Cancer Center Amsterdam, Amsterdam, The Netherlands
4   Department of Gastroenterology and Hepatology, Amsterdam UMC, location Vrije Universiteit, Amsterdam, The Netherlands
,
Marc G. Besselink
2   Amsterdam Gastroenterology Endocrinology Metabolism, Research Institute, Amsterdam, The Netherlands
3   Treatment and Quality of life, Cancer Center Amsterdam, Amsterdam, The Netherlands
5   Department of Surgery, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands
,
Olivier R. Busch
2   Amsterdam Gastroenterology Endocrinology Metabolism, Research Institute, Amsterdam, The Netherlands
3   Treatment and Quality of life, Cancer Center Amsterdam, Amsterdam, The Netherlands
5   Department of Surgery, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands
,
Freek Daams
2   Amsterdam Gastroenterology Endocrinology Metabolism, Research Institute, Amsterdam, The Netherlands
3   Treatment and Quality of life, Cancer Center Amsterdam, Amsterdam, The Netherlands
6   Department of Surgery, Amsterdam UMC, location Vrije Universiteit, Amsterdam, The Netherlands
,
Nahid S. M. Montazeri
2   Amsterdam Gastroenterology Endocrinology Metabolism, Research Institute, Amsterdam, The Netherlands
7   Department of Gastroenterology and Hepatology, Biostatistics Unit, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands
,
Johanna W. Wilmink
2   Amsterdam Gastroenterology Endocrinology Metabolism, Research Institute, Amsterdam, The Netherlands
3   Treatment and Quality of life, Cancer Center Amsterdam, Amsterdam, The Netherlands
8   Department of Medical Oncology, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands
,
Rogier P. Voermans‡   ‡
1   Department of Gastroenterology and Hepatology, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands
2   Amsterdam Gastroenterology Endocrinology Metabolism, Research Institute, Amsterdam, The Netherlands
3   Treatment and Quality of life, Cancer Center Amsterdam, Amsterdam, The Netherlands
,
Roy L. J. Van Wanrooij  ‡   ‡
2   Amsterdam Gastroenterology Endocrinology Metabolism, Research Institute, Amsterdam, The Netherlands
3   Treatment and Quality of life, Cancer Center Amsterdam, Amsterdam, The Netherlands
4   Department of Gastroenterology and Hepatology, Amsterdam UMC, location Vrije Universiteit, Amsterdam, The Netherlands
› Author AffiliationsTrial Registration: Netherlands National Trial Register Registration number (trial ID): NL9757 Type of study: Prospective
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Referred to by:

Author commentary on Jeska A. Fritzsche et al.Endoscopy 2024; 56(01): v1-v1
DOI: 10.1055/a-2159-4075

Referred to by:

Endoscopic ultrasound-guided choledochoduodenostomy: is the rate of stent dysfunction underestimated?Endoscopy 2024; 56(01): 53-55
DOI: 10.1055/a-2193-5791

Abstract

Background This study aimed to assess the safety and feasibility of endoscopic ultrasound-guided choledochoduodenostomy (EUS-CDS) using a lumen-apposing metal stent (LAMS) as a primary drainage strategy in patients with distal malignant biliary obstruction (MBO).

Methods A prospective, single-center, pilot study was conducted in patients with pathology-confirmed MBO without gastric outlet obstruction. The primary outcome was technical success. Secondary outcomes included clinical success, adverse events (AEs), and reinterventions. The study was registered in the Netherlands Trial Registry (registry number NL9757).

Results 22 patients were enrolled (median age 69.5 years [interquartile range 64–75.3]). Technical success was achieved in 20/22 patients (91 %). AEs occurred in one patient, namely perforation following inadequate stent deployment (5 %), which was treated in the same procedure. Clinical success was achieved in 19/22 patients (86 %). Stent dysfunction was observed in 11/20 patients (55 %) after technically successful EUS-CDS: two patients were treated conservatively and nine patients underwent reintervention(s). One patient died within ≤ 30 days due to fulminant disease progression.

Conclusions The results confirmed the safety and feasibility of EUS-CDS using LAMS as a primary drainage strategy. The high incidence of stent dysfunction should be improved before EUS-CDS with LAMS can be seen as a valid alternative to endoscopic retrograde cholangiopancreatography.

‡ Contributed equally to the work.


Table 1 s, Figs. 1 s, 2 s



Publication History

Received: 13 February 2023

Accepted after revision: 20 July 2023

Accepted Manuscript online:
20 July 2023

Article published online:
23 August 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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