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DOI: 10.1055/s-0041-1724356
Eus-Guided Choledochoduodenostomy Using a Lumen-Apposing Metal Stent for Malignant Distal Biliary Obstruction: a Retrospective Multicenter Analysis
Aims Endoscopic ultrasound-guided choledochoduodenostomy (EUS-CDS) with lumen apposing metal stent (LAMS) has emerged as a procedure with encouraging results in terms of safety and effectiveness in patients with malignant distal biliary obstruction and failed endoscopic retrograde cholangiopancreatography (ERCP).
Methods This is a multicenter, retrospective analysis including all cases of EUS-CDS with LAMS performed in patients with malignant distal biliary obstruction and failed ERCP in 23 Italian Centers from February 2015 to July 2020.
Primary endpoints were technical and clinical success. Secondary endpoint was the adverse events (AEs) rate.
Results A total of 256 patients (55.1 % males) with a mean age of 73.6 ± 12.4 were included in the study. The most common etiology of biliary stricture was pancreatic adenocarcinoma (75.4 %), followed by ampullary cancer (8.6 %) and cholangiocarcinoma (7.0 %). The common bile duct median diameter was 17.0 ± 4.0 mm. Technical and clinical success were achieved in 93.0 % and 89.5 % of cases respectively, with a mean bilirubin reduction at two weeks of 73 %. Median procedure time was 28.0 minutes. The mean follow-up was 148.1 days. Forty-nine AEs (13 mild, 28 moderate and 8 severe) occurred in 46 patients (18 %) and were classified as intraprocedural 21 (42.9 %), early < 15 days 10 (20.4 %), delayed > 15 days 18 (37.6 %). No fatal AE occurred.
Conclusions The results of our study show that EUS-guided biliary drainage with LAMS in case of malignant distal biliary obstruction in patients with failed ERCP represents a viable alternative in terms of effectiveness, safety and long-term result with an acceptable adverse event rate. To the best of our knowledge this is the largest study in the literature concerning this procedure.
Citation: Fugazza A, Fabbri C, Di Mitri R et al. OP97 EUS-GUIDED CHOLEDOCHODUODENOSTOMY USING A LUMEN-APPOSING METAL STENT FOR MALIGNANT DISTAL BILIARY OBSTRUCTION: A RETROSPECTIVE MULTICENTER ANALYSIS. Endoscopy 2021; 53: S41.
Publication History
Article published online:
19 March 2021
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