Top

Published in:

01-11-2019 | Endoscopic Retrograde Cholangiopancreatography | Original Article

EUS-Guided Choledochoduodenostomy for Distal Malignant Biliary Obstruction Using Electrocautery-Enhanced Lumen-Apposing Metal Stents: First US, Multicenter Experience

Authors: Abdul H. El Chafic, Janak N. Shah, Chris Hamerski, Kenneth F. Binmoeller, Shayan Irani, Theodore W. James, Todd H. Baron, Jose Nieto, Ricardo V. Romero, John A. Evans, Michel Kahaleh

Published in: Digestive Diseases and Sciences | Issue 11/2019

Abstract

Background and Aims

EUS-guided biliary drainage has emerged as a technique to enable endobiliary drainage in failed ERCP. A newer model, lumen-apposing metal stents (LAMS), with a cautery-enhanced delivery system became available in the USA in late 2015. This cautery-tipped version may facilitate EUS-guided choledochoduodenostomy (EUS-CD), but data using this model are lacking.

Methods

We reviewed outcomes of attempted EUS-CD using cautery-enhanced LAMS from 6, US centers. The following data were collected: patient and procedure details, technical success, adverse events, clinical success (resolution of jaundice or improvement in bilirubin > 50%), and biliary re-interventions.

Results

EUS-CD was attempted in 67 patients (mean age 68.8) with malignant obstruction after failed ERCP between September 2015 and April 2018. EUS-CD was technically successful in 64 (95.5%). A plastic or metal stent was inserted through the lumen of the deployed LAMS in 50 of 64 (78.1%) patients to maintain a non-perpendicular LAMS axis into the bile duct. Adverse events occurred in 4 (6.3%) and included: abdominal pain (n = 2), peritonitis that responded to antibiotics (n = 1), and bleeding requiring transfusion (n = 1). Among 40 patients with follow-up of > 4 weeks, clinical success was achieved in 100%. Biliary re-interventions for obstruction were needed in 7(17.5%), in 3 of 6 (50.0%) that underwent EUS-CD with LAMS alone versus 4 of 34 (5%) with LAMS plus an axis-orienting stent (p = 0.02).

Conclusion

EUS-CD using LAMS with cautery-enhanced delivery systems has high technical and clinical success rates, with a low rate of adverse events. Inserting an axis-orienting stent through the lumen of the LAMS may reduce the need for biliary re-interventions.

Enochsson L, Swahn F, Arnelo U, Nilsson M, Lohr M, Persson G. Nationwide, population-based data from 11,074 ERCP procedures from the Swedish Registry for Gallstone Surgery and ERCP. Gastrointest Endosc. 2010;72:1175–1184. https://doi.org/10.1016/j.gie.2010.07.047. 84 e1–3.CrossRefPubMed

Peng C, Nietert PJ, Cotton PB, Lackland DT, Romagnuolo J. Predicting native papilla biliary cannulation success using a multinational Endoscopic Retrograde Cholangiopancreatography (ERCP) Quality Network. BMC Gastroenterol. 2013;13:147. https://doi.org/10.1186/1471-230X-13-147.CrossRefPubMedPubMedCentral

Williams EJ, Ogollah R, Thomas P, et al. What predicts failed cannulation and therapy at ERCP? Results of a large-scale multicenter analysis. Endoscopy. 2012;44:674–683. https://doi.org/10.1055/s-0032-1309345.CrossRefPubMed

Giovannini M, Moutardier V, Pesenti C, Bories E, Lelong B, Delpero JR. Endoscopic ultrasound-guided bilioduodenal anastomosis: a new technique for biliary drainage. Endoscopy. 2001;33:898–900. https://doi.org/10.1055/s-2001-17324.CrossRefPubMed

Lee TH, Choi JH, do Park H, et al. Similar efficacies of endoscopic ultrasound-guided transmural and percutaneous drainage for malignant distal biliary obstruction. Clin Gastroenterol Hepatol. 2016;14:1011–1019. https://doi.org/10.1016/j.cgh.2015.12.032. e3.CrossRefPubMed

Nennstiel S, Weber A, Frick G, et al. Drainage-related Complications in percutaneous transhepatic biliary drainage: an analysis over 10 years. J Clin Gastroenterol. 2015;49:764–770. https://doi.org/10.1097/MCG.0000000000000275.CrossRefPubMed

Burmester E, Niehaus J, Leineweber T, Huetteroth T. EUS-cholangio-drainage of the bile duct: report of 4 cases. Gastrointest Endosc. 2003;57:246–251. https://doi.org/10.1067/mge.2003.85.CrossRefPubMed

Kawakubo K, Isayama H, Kato H, et al. Multicenter retrospective study of endoscopic ultrasound-guided biliary drainage for malignant biliary obstruction in Japan. J Hepatobiliary Pancreat Sci. 2014;21:328–334. https://doi.org/10.1002/jhbp.27.CrossRefPubMed

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. https://doi.org/10.1007/s00464-016-4845-6.CrossRefPubMed

10.

Tsuchiya T, Teoh AYB, Itoi T, et al. Long-term outcomes of EUS-guided choledochoduodenostomy using a lumen-apposing metal stent for malignant distal biliary obstruction: a prospective multicenter study. Gastrointest Endosc. 2018;87:1138–1146. https://doi.org/10.1016/j.gie.2017.08.017.CrossRefPubMed

11.

Soehendra N, Reynders-Frederix V. Palliative bile duct drainage—a new endoscopic method of introducing a transpapillary drain. Endoscopy. 1980;12:8–11. https://doi.org/10.1055/s-2007-1021702.CrossRefPubMed

12.

Dhir V, Isayama H, Itoi T, et al. Endoscopic ultrasonography-guided biliary and pancreatic duct interventions. Dig Endosc. 2017;29:472–485. https://doi.org/10.1111/den.12818.CrossRefPubMed

13.

Ogura T, Higuchi K. Does endoscopic ultrasound-guided biliary drainage really have clinical impact? World J Gastroenterol. 2015;21:1049–1052. https://doi.org/10.3748/wjg.v21.i4.1049.CrossRefPubMedPubMedCentral

14.

Yamao K, Kitano M, Takenaka M, et al. Outcomes of endoscopic biliary drainage in pancreatic cancer patients with an indwelling gastroduodenal stent: a multicenter cohort study in West Japan. Gastrointest Endosc. 2018;88:66–75. https://doi.org/10.1016/j.gie.2018.01.021. e2.CrossRefPubMed

15.

Hara K, Yamao K, Niwa Y, et al. Prospective clinical study of EUS-guided choledochoduodenostomy for malignant lower biliary tract obstruction. Am J Gastroenterol. 2011;106:1239–1245. https://doi.org/10.1038/ajg.2011.84.CrossRefPubMed

16.

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. https://doi.org/10.1097/MCG.0b013e31828c6822.CrossRefPubMed

17.

Fabbri C, Luigiano C, Fuccio L, et al. EUS-guided biliary drainage with placement of a new partially covered biliary stent for palliation of malignant biliary obstruction: a case series. Endoscopy. 2011;43:438–441. https://doi.org/10.1055/s-0030-1256097.CrossRefPubMed

18.

Bang JY, Navaneethan U, Hasan M, Hawes R, Varadarajulu S. Stent placement by EUS or ERCP for primary biliary decompression in pancreatic cancer: a randomized trial (with videos). Gastrointest Endosc. 2018;. https://doi.org/10.1016/j.gie.2018.03.012.CrossRefPubMed

19.

Paik WH, Lee TH, Park DH, et al. EUS-guided biliary drainage versus ERCP for the Primary palliation of malignant biliary obstruction: a multicenter randomized clinical trial. Am J Gastroenterol. 2018;. https://doi.org/10.1038/s41395-018-0122-8.CrossRefPubMed

20.

Martins FP, Rossini LG, Ferrari AP. Migration of a covered metallic stent following endoscopic ultrasound-guided hepaticogastrostomy: fatal complication. Endoscopy. 2010;42:E126–E127. https://doi.org/10.1055/s-0029-1243911.CrossRefPubMed

21.

Paik WH, Lee TH, Park DH, et al. EUS-guided biliary drainage versus ERCP for the primary palliation of malignant biliary obstruction: a multicenter randomized clinical trial. Am J Gastroenterol. 2018;113:987–997. https://doi.org/10.1038/s41395-018-0122-8.CrossRefPubMed

22.

Anderloni A, Fugazza A, Troncone E, et al. Single-stage EUS-guided choledochoduodenostomy using a lumen-apposing metal stent for malignant distal biliary obstruction. Gastrointest Endosc. 2019;89:69–76. https://doi.org/10.1016/j.gie.2018.08.047.CrossRefPubMed

Title: EUS-Guided Choledochoduodenostomy for Distal Malignant Biliary Obstruction Using Electrocautery-Enhanced Lumen-Apposing Metal Stents: First US, Multicenter Experience
Authors: Abdul H. El Chafic
Janak N. Shah
Chris Hamerski
Kenneth F. Binmoeller
Shayan Irani
Theodore W. James
Todd H. Baron
Jose Nieto
Ricardo V. Romero
John A. Evans
Michel Kahaleh
Publication date: 01-11-2019
Publisher: Springer US
Keyword: Endoscopic Retrograde Cholangiopancreatography
Published in: Digestive Diseases and Sciences / Issue 11/2019
Print ISSN: 0163-2116
Electronic ISSN: 1573-2568
DOI: https://doi.org/10.1007/s10620-019-05688-2

Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Reserve your place

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin

Prof. Florian Limbourg

Prof. Anoop Chauhan

Developed by: Springer Medicine

Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background and Aims

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 11/2019

Does Biliodigestive Anastomosis Have Any Effect on the Reversal of Hepatopulmonary Syndrome in a Biliary Cirrhosis Experimental Model?

Retraction Note to: Effect of miR-451 on the Biological Behavior of the Esophageal Carcinoma Cell Line EC9706

Prophylactic Snare Tip Soft Coagulation and Its Impact on Adenoma Recurrence After Colonic Endoscopic Mucosal Resection

The Altered Mucosal Barrier Function in the Duodenum Plays a Role in the Pathogenesis of Functional Dyspepsia

Simkania negevensis in Crohn’s Disease

Foregone Inclusion: Neonatal CMV Hepatitis and Cholestasis

Keynote webinar | Spotlight on medication adherence

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

At a glance: The STEP trials