Long-Lasting Lumen Apposing Metal Stents In The Management Of Biliary Disorders In Excluded Jejunal Limb: Long Term Results And Adverse Events

Aims The endoscopic ultrasound (EUS)-guided positioning of lumen apposing metal stents (LAMS) allows the creation of endoscopic anastomosis of the digestive tract (EDA) to have access to the surgically excluded biliary tract in patients with biliary disorders and previous foregut surgeries.

This study analyzes a series of EDA with LAMS permanent placement at long follow-up.

Methods Patients who received a EUS-guided EDA between January 2017 and September 2020 were retrospectively analyzed.

After the EUS-guided location of the excluded loop, the endoscopic anastomosis was performed through direct LAMS placement (EUS-direct) or after a previous opacification with a 19gauge endoscopic needle (19G) or through an endoscopic-radiologic rendez-vous (RDV) from a percutaneous-transhepatic-biliary-drainage (PTBD). Multiple endoscopic retrograde cholangiographies were then performed to treat the biliary disorder using the EDA as permanent access. Patients with clinical success underwent an annual follow-up being LAMS removal scheduled at 5 years for benign pathologies and not scheduled for malignant pathologies.

Results Twenty-two patients underwent 2 gastro-jejunal, 15 duodeno-jejunal and 5 jejuno-jejunal anastomoses (seven EUS -direct, two 19G and twelve RDV).

Twelve patients (54.5 %) ended the biliary disorder treatment, 2 patients (9.1 %) had technical failure and 8 patients (36.4 %) are still under treatment.

At a median follow-up of 521.5 days there were 4 adverse events: 1 LAMS was not found at endoscopic control, persisting a 6mm diameter anastomosis, reopened through a diabolo-shaped stent; 2/2 gastrojejunal anastomosis presented buried LAMS which were replaced with diabolo-shaped stents; 1 intraoperative displacement of the duodenojejunal LAMS was solved by removing it, clipping the jejunal side with an over-the-scope-clip and draining the duodenal side through a PTBD.

Conclusions Despite the need to develop a standard technique, long-term LAMS placement for a permanent access to chronic biliary disorders is feasible and safe. In our experience, gastro-jejunal anastomosis have a higher risk of adverse events.

Citation Spota A, Cereatti F, Derhy S et al. eP438 LONG-LASTING LUMEN APPOSING METAL STENTS IN THE MANAGEMENT OF BILIARY DISORDERS IN EXCLUDED JEJUNAL LIMB: LONG TERM RESULTS AND ADVERSE EVENTS. Endoscopy 2021; 53: S241.

Publication History

Article published online:
19 March 2021