EUS-guided biliary drainage with a novel electrocautery-enhanced lumen apposing metal stent as first approach for distal malignant biliary obstruction: a prospective study

Abstract

Background and study aims Endoscopic retrograde cholangiopancreatography (ERCP) represents the gold standard for jaundice palliation in malignant biliary obstruction (MBO) patients. Biliary drainage using electrocautery lumen apposing metal stent (EC-LAMS) is currently a well-established procedure when ERCP fails. We aimed to assess the technical and clinical success of a new EC-LAMS as the first approach to the palliation of malignant jaundice due to MBO in patients unfit for surgery.

Patients and methods Twenty-five consecutive patients undergoing endoscopic-guided biliary drainage with the new EC-LAMS were prospectively enrolled. Clinical success was defined as bilirubin level decrease > 15 % 24 hours after EC-LAMS placement.

Results Mean age was 76.6 ± 11.56 years, and male patients were 10 (40 %). EC-LAMS placement was technically feasible in 24 patients (96 %) and clinical success rate was 100 %. Only one patient (4 %) experienced a misplacement rescued by an immediate second EC-LAMS placement. The mean duration of hospital stay was 4.66 ± 4.22 days. The median overall survival was 7 months (95 % CI 1–7).

Conclusions In this preliminary study, the new EC-LAMS seems to allow a single-step palliative endoscopic therapy in patients affected by jaundice due to MBO, with high technical and clinical success and low adverse events. Further large prospective studies are warranted to validate these results.

Publikationsverlauf

Eingereicht: 21. Februar 2022

Angenommen nach Revision: 21. April 2022

Artikel online veröffentlicht:
15. Juli 2022

• References

• 1 Dumonceau JM, Tringali A, Papanikolaou IS. et al. Endoscopic biliary stenting: indications, choice of stents, and results: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline - Updated October 2017. Endoscopy 2018; 50: 910-930
• 2 Enochsson L, Swahn F, Arnelo U. et al. Nationwide, population-based data from 11,074 ERCP procedures from the Swedish Registry for Gallstone Surgery and ERCP. Gastrointest Endosc 2010; 72: 1175-1184
• 3 Voegeli DR, Crummy AB, Weese JL. Percutaneous transhepatic cholangiography, drainage, and biopsy in patients with malignant biliary obstruction. An alternative to surgery. Am J Surg 1985; 150: 243-247
• 4 Winick AB, Waybill PN, Venbrux AC. Complications of percutaneous transhepatic biliary interventions. Tech Vasc Interv Radiol 2001; 4: 200-206
• 5 Giovannini M, Moutardier V, Pesenti C. et al. Endoscopic ultrasound-guided bilioduodenal anastomosis: a new technique for biliary drainage. Endoscopy 2001; 33: 898-900
• 6 Kunda R, Perez-Miranda M, Will U. et al. EUS-guided choledochoduodenostomy for malignant distal biliary obstruction using a lumen-apposing fully covered metal stent after failed ERCP. Surg Endosc 2016; 30: 5002-5008
• 7 Hedjoudje A, Sportes A, Grabar S. et al. Outcomes of endoscopic ultrasound-guided biliary drainage: A systematic review and meta-analysis. United European Gastroenterol J 2019; 7: 60-68
• 8 Guo J, Giovannini M, Sahai AV. et al. A multi-institution consensus on how to perform EUS-guided biliary drainage for malignant biliary obstruction. Endosc Ultrasound 2018; 7: 356-365
• 9 Mangiavillano B, Auriemma F, Bianchetti M. et al. A cholecystoduodenostomy with a new type of lumen-apposing metal stent. Dig Liv Dis 2021; 53: 1203
• 10 Mangiavillano B, Moon JH, Crinò SF. et al. Safety nd efficacy of a novel electrocautery-enhanced lumen-apposing metal stent in interventional EUS procedures. Gastrointest Endosc 2022; 95: 115-122
• 11 Mangiavilano B, Auriemma F, Lamonaca L. et al. A novel lumen apposing metal stent with an electrocautery-tip for different indications: initial experience in a referral center. Dig Dis 2021; 4: 1-7
• 12 Theo AYB, Kongkam P, Bapaye A. et al. Use of a novel lumen apposing metallic stent for drainage of the bile duct and gallbladder: Long term outcomes of a prospective international trial. Dig Endosc 2021; 33: 1139-1145
• 13 On W, Paranandi B, Smith AM. et al. EUS-guided choledochoduodenostomy with electrocautery-enhanced lumen-apposing metal stents in patients with malignant distal biliary obstruction: multicenter collaboration from the United Kingdom and Ireland. Gastrointest Endosc 2022; 95: 432-442
• 14 Mangiavillano B, Auriemma F, Mezzanzanica M. et al. Fine needle biopsy plus EUS-guided cholecystojejunostomy by LAMS with a water-filled technique in a patient with Roux-En-Y reconstruction. Am J Gastroenterol 2020; 115: 1572
• 15 Mangiavillano B, Carrara S, Eusebi LH. et al. Water-filled technique for therapeutic pancreato-biliary EUS in patients with surgically altered anatomy. Endosc Int Open 2021; 9: E487-E489
• 16 Tarantino I, Peralta M, Ligresti D. et al. Endoscopic ultrasound-guided biliary drainage of malignant stenosis, not treatable with endoscopic retrograde cholangiopancreatography: a single-center, prospective observational study. Endosc Int Open 2021; 9: E110-E115
• 17 Anderloni A, Fugazza A, Troncone A. et al. Single-stage EUS-guided choledochoduodenostomy using a lumen-apposing metal stent for malignant distal biliary obstruction. Gastrointest Endosc 2019; 89: 69-76
• 18 Mangiavillano B, Khashab MA, Tarantino I. et al. Success and safety of endoscopic treatments for concomitant biliary and duodenal malignant stenosis: A review of the literature. World J Gastrointest Surg 2019; 11: 53-61
• 19 Mangiavillano B, Auriemma F, Paduano D. et al. How to solve a malplacement of a luminal apposing metal stent during cholecystogastrostomy: perform an immediate second one!. Endoscopy 2021;
• 20 Yoo HW, Moon JH, Jo SJ. et al. A novel electrocautery-enhanced delivery system for one-step endoscopic ultrasound-guided drainage of the gallbladder and bile duct using a lumen-apposing metal stent: a feasibility study. Endoscopy 2021; 53: 922-926
• 21 Mangiavillano B, Montale A, Frazzoni L. et al. Endoscopic biliary self-expandable metallic stent in malignant biliary obstruction with or without sphincterotomy: systematic review and meta-analysis. Endosc Int Open 2019; 7: E26-E35