Long-term placement of lumen-apposing metal stent after endoscopic ultrasound-guided duodeno- and jejunojejunal anastomosis for direct access to excluded jejunal limb

Abstract

Background Management of biliary disorders in patients with altered anatomy may be challenging. Endoscopic ultrasound (EUS)-guided gastrointestinal anastomosis using a lumen-apposing metal stent (LAMS) was introduced to allow endoscopic retrograde cholangiography (ERC) in such cases. However, the appropriate stent indwelling time remains uncertain. We report long-term LAMS deployment after duodenojejunal or jejunojejunal anastomosis (EUS-DJA) to allow endoscopic reinterventions in cases of recurrences.

Methods 11 consecutive patients underwent EUS-DJA with long-standing LAMS between January 2017 and December 2018. Over a 12-month period, ERC treatment was carried out with multiple endoscopic sessions across the DJA.

Results Technical success was 91 % (10/11) for EUS-DJA and 100 % for ERC. Four patients presented stricture recurrence at a mean of 489 days (standard deviation [SD] 31.7) after the end of ERC treatment. A novel ERC across the LAMS anastomosis was feasible in all cases. At a mean of 781 days (SD 253.1), all LAMS remained in place with no evidence of complications.

Conclusion Long-term LAMS placement after EUS-DJA may be feasible and safe for direct access to the excluded limb.

Publication History

Received: 27 April 2020

Accepted: 22 June 2020

Article published online:
06 August 2020

• References

• 1 Cantwell CP, Pena CS, Gervais DA. Thirty years’ experience with balloon dilation of benign postoperative biliary strictures: long-term outcomes. Radiology 2008; 249: 1050-1057
• 2 Braden B, Gupta V, Dietrich CF. Therapeutic EUS: new tools, new devices, new applications. Endosc Ultrasound 2019; 8: 370-381
• 3 Dimou FM, Adhikari D, Mehta HB. et al. Incidence of hepaticojejunostomy stricture after hepaticojejunostomy. Surgery 2016; 160: 691-698
• 4 Walsh RM, Henderson JM, Vogt DP. et al. Long-term outcome of biliary reconstruction for bile duct injuries from laparoscopic cholecystectomies. Surgery 2007; 142: 150
• 5 Parlak E, Disibeyaz S, Oztas E. et al. Endoscopic treatment of biliary disorders in patients with Roux-en-Y hepaticojejunostomy via a permanent access loop. Endoscopy 2011; 43: 73-76
• 6 Fang K, Chou TC. Subcutaneous blind loop in a new type of hepatico choledocho-jejunostomy for bilateral intrahepatic calculi. Chin Med J 1977; 3: 361-368
• 7 Skinner M, Popa D, Neumann H. et al. ERCP with the overtube-assisted enteroscopy technique: a systematic review. Endoscopy 2014; 46: 560-572
• 8 Jain D, Chhoda A, Sharma A. et al. De-novo gastrointestinal anastomosis with lumen apposing metal stent. Clin Endosc 2018; 51: 439-449
• 9 Iqbal U, Khara HS, Hu Y. et al. EUS-guided gastroenterostomy for the management of gastric outlet obstruction: a systematic review and meta-analysis. Endosc Ultrasound 2020; 9: 16-23
• 10 Taibi A, Durand Fontanier S, Derbal S. et al. What is the ideal indwelling time for metal stents after endoscopic ultrasound-guided gastrojejunostomy? Case report of delayed iatrogenic perforation with a review of the literature. Dig Endosc 2020;
• 11 Mutignani M, Forti E, Larghi A. et al. Endoscopic entero-enteral bypass: an effective new approach to the treatment of postsurgical complications of hepaticojejonostomy. Endoscopy 2019; 51: 1146-1150
• 12 Pournaras DJ, Glicksman C, Vincent RP. et al. The role of bile after Roux-en-Y gastric bypass in promoting weight loss and improving glycaemic control. Endocrinology 2012; 153: 3613-3619