Advertisement

Long-term outcomes of EUS-guided choledochoduodenostomy using a lumen-apposing metal stent for malignant distal biliary obstruction: a prospective multicenter study

Published:August 23, 2017DOI:https://doi.org/10.1016/j.gie.2017.08.017

      Background and Aims

      EUS-guided choledochoduodenostomy (EUS-CDS) using conventional tubular stents has been successfully performed. However, EUS-CDS carries a high risk of bile leakage with attendant adverse events. This study aimed to prospectively evaluate the long-term outcome of EUS-CDS using a dedicated lumen-apposing metal stent (LAMS).

      Methods

      Nineteen patients (mean age, 70.6 years; 12 men) with unresectable malignant diseases were treated in 5 tertiary referral centers. EUS-CDS was performed using a fully covered LAMS with a cautery-enhanced delivery system for EUS-CDS.

      Results

      All stents were successfully deployed without any adverse events. Jaundice improved in 79% of the patients within 7 days and finally in 95%. In 95% of patients the stents remained in good anastomotic position without migration or dislocation during the follow-up period (median, 184 days; range, 12-819). One patient had a fever the day after stent placement. During the follow-up period 5 patients had secondary stent obstruction because of food residue (n = 2), kinking (n = 1), suspected tumor ingrowth (n = 1), and spontaneous dislodgement (n = 1). Five patients developed obstruction in the second portion of the duodenum. The overall adverse event rate was 36.8% (7/19), mostly with mild severity.

      Conclusions

      This study revealed that the novel dedicated LAMS used has high technical and clinical success rates for EUS-CDS. The adverse events and patency rates are inferior to the historically reported data of a conventional transpapillary metal stent. Development of a more suitable dedicated LAMS is anticipated.

      Abbreviations:

      EUS-CDS (EUS-guided choledochoduodenostomy), LAMS (lumen-apposing metal stent), SEMS (self-expandable metal stent)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Gastrointestinal Endoscopy
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Giovanini M.
        • Moutardier V.
        • Pesenti C.
        • et al.
        Endoscopic ultrasound-guided bilioduodenal anastomosis: a new technique for biliary drainage.
        Endoscopy. 2001; 33: 898-900
        • Kahaleh M.
        • Hernandez A.J.
        • Tokar J.
        • et al.
        Interventional EUS-guided cholangiography: evaluation of a technique in evolution.
        Gastrointest Endosc. 2006; 64: 52-59
        • Yamao K.
        • Sawaki A.
        • Takahashi K.
        • et al.
        EUS-guided choledochoduodenostomy for palliative biliary drainage in case of papillary obstruction: report of 2 cases.
        Gastrointest Endosc. 2006; 64: 663-667
        • Tarantino I.
        • Barresi L.
        • Repici A.
        • et al.
        EUS-guided biliary drainage: a case series.
        Endoscopy. 2008; 40: 336-339
        • Park D.H.
        • Koo J.E.
        • Oh J.
        • et al.
        EUS-guided biliary drainage with one-step placement of a fully covered metal stent for malignant biliary obstruction: a prospective feasibility study.
        Am J Gastroenterol. 2009; 104: 2168-2174
        • Hara K.
        • Yamao K.
        • Hijioka S.
        • et al.
        Prospective clinical study of endoscopic ultrasound-guided choledochoduodenostomy with direct metallic stent placement using a forward-viewing echoendoscope.
        Endoscopy. 2013; 45: 392-396
        • Itoi T.
        • Isayama H.
        • Sofuni A.
        • et al.
        Stent selection and tips of placement technique of EUS-guided biliary drainage: trans-duodenal and trans-gastric stenting.
        J Hepatobiliary Pancreat Sci. 2011; 18: 664-672
        • Binmoeller K.F.
        • Shah J.N.
        Endoscopic ultrasound-guided gastroenterostomy using novel tools designed for transluminal therapy: a porcine study.
        Endoscopy. 2012; 44: 499-503
        • Binmoeller K.B.
        • Shah J.
        A novel lumen-apposing stent for transluminal drainage of nonadherent extraintestinal fluid collections.
        Endoscopy. 2011; 43: 337-342
        • Itoi T.
        • Binmoeller
        • Shah J.
        • et al.
        Clinical evaluation of a novel lumen-apposing metal stent for endosonography-guided pancreatic pseudocyst and gallbladder drainage (with video).
        Gastrointest Endosc. 2012; 75: 870-876
        • Itoi T.
        • Binmoeller K.F.
        • Itokawa F.
        • et al.
        EUS-guided cholecystogastrostomy using lumen-apposing metal stent as an alternative extrahepatic bile duct drainage in pancreatic cancer with duodenal invasion: a case report.
        Dig Endosc. 2013; 25: 137-141
        • Itoi T.
        • Binmoeller K.F.
        EUS-guided anastomosis.
        Gastrointest Endosc Clin North Am. 2012; 22: 371-377
        • Teoh A.Y.
        • Binmoeller K.F.
        • Lau J.Y.
        Single-step EUS-guided puncture and delivery of a lumen-apposing stent for gallbladder drainage using a novel cautery-tipped stent delivery system.
        Gastrointest Endosc. 2014; 80: 1171
        • Glessing B.R.
        • Mallery S.
        • Freeman M.L.
        • et al.
        EUS-guided choledochoduodenostomy with a lumen-apposing metal stent before duodenal stent placement for malignant biliary and duodenal obstruction.
        Gastrointest Endosc. 2015; 81: 1019-1020
        • Fabbri C.
        • Luigiano C.
        • Lisotti A.
        • et al.
        Endoscopic ultrasound-guided treatments: Are we getting evidence based. A systematic review.
        World J Gastroenterol. 2014; 20: 8424-8448
        • Kunda R.
        • Pérez-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
        • Gupta K.
        • Perez-Miranda M.
        • Kahaleh M.
        • et al.
        Endoscopic ultrasound-assisted bile duct access and drainage: multicenter, long-term analysis of approach, outcomes, and complications of a technique in evolution.
        J Clin Gastroenterol. 2014; 48: 80-87
        • Itoi T.
        • Binmoeller K.F.
        EUS-guided choledochoduodenostomy using a biflanged lumen-apposing metal stent (with video).
        Gastrointest Endosc. 2014; 79: 715
        • Tarantino I.
        • Barresi L.
        • Granata A.
        • et al.
        Single-step EUS-guided choledocoduodenostomy and stenting.
        Gastrointest Endosc. 2015; 81: 1016-1017
        • Cotton P.B.
        • Eisen G.M.
        • Aabakken L.
        • et al.
        A lexicon for endoscopic adverse events: report of an ASGE workshop.
        Gastrointest Endosc. 2010; 71: 446-454
        • Iwashita T.
        • Doi S.
        • Yasuda I.
        Endoscopic ultrasound-guided biliary drainage: a review.
        Clin J Gastroenterol. 2014; 7: 94-102
        • Loew B.J.
        • Howell D.A.
        • Sanders M.K.
        • et al.
        Comparative performance of uncoated, self-expanding metal biliary stents of different designs in 2 diameters: final results of an international multicenter, randomized, controlled trial.
        Gastrointest Endosc. 2009; 70: 445-453
        • Storm A.C.
        • Thompson C.C.
        Endoscopic management of sump syndrome resulting from endoscopic choledochogastrostomy.
        Gastrointest Endosc. 2016; 83: 1037