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
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Article info
Publication history
Published online: August 23, 2017
Accepted:
August 6,
2017
Received:
May 29,
2017
Footnotes
DISCLOSURE: The following author disclosed financial relationships relevant to this publication: T. Itoi: Consultant for Xlumena Inc. All other authors disclosed no financial relationships relevant to this publication. Research support for this study was provided by Xlumena Inc. for supplying the AXIOS stents free of charge.
If you would like to chat with an author of this article, you may contact Dr Itoi at [email protected]
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© 2018 by the American Society for Gastrointestinal Endoscopy
