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17-04-2023 | Ultrasound | Pancreatic Tumors

Pancreatoduodenectomy Following Preoperative Biliary Drainage Using Endoscopic Ultrasound-Guided Choledochoduodenostomy Versus a Transpapillary Stent: A Multicenter Comparative Cohort Study of the ACHBT–FRENCH–SFED Intergroup

Authors: Julien Janet, MD, Jeremie Albouys, MD, Bertrand Napoleon, MD, PhD, Jeremie Jacques, MD, PhD, Muriel Mathonnet, MD, PhD, Julien Magne, MD, PhD, Marie Fontaine, MD, Charles de Ponthaud, MD, Sylvaine Durand Fontanier, MD, Sylvia S. M. Bardet, PhD, Raphael Bourdariat, MD, PhD, Laurent Sulpice, MD, PhD, Mickael Lesurtel, MD, PhD, Romain Legros, MD, Stephanie Truant, MD, PhD, Fabien Robin, MD, PhD, Frédéric Prat, MD, PhD, Maxime Palazzo, MD, PhD, Lilian Schwarz, MD, PhD, Emmanuel Buc, MD, PhD, Alain Sauvanet, MD, PhD, Sebastien Gaujoux, MD, PhD, Abdelkader Taibi, MD, PhD

Published in: Annals of Surgical Oncology | Issue 8/2023

Abstract

Background

It is unclear whether preoperative biliary drainage (PBD) by endoscopic retrograde cholangiopancreatography (ERCP) is equivalent to electrocautery-enhanced lumen-apposing metal stent (ECE-LAMS) before pancreatoduodenectomy (PD).

Methods

Patients who underwent PBD for distal malignant biliary obstruction (DMBO) followed by PD were retrospectively included in nine expert centers between 2015 and 2022. ERCP or endoscopic ultrasound-guided choledochoduodenostomy with ECE-LAMS were performed. In intent-to-treat analysis, patients drained with ECE-LAMS were considered the study group (first-LAMS group) and those drained with conventional transpapillary stent the control group (first-cannulation group). The rates of technical success, clinical success, drainage-related complications, surgical complications, and oncological outcomes were analyzed.

Results

Among 156 patients, 128 underwent ERCP and 28 ECE-LAMS in first intent. The technical and clinical success rates were 83.5% and 70.2% in the first-cannulation group versus 100% and 89.3% in the first-LAMS group (p = 0.02 and p = 0.05, respectively). The overall complication rate over the entire patient journey was 93.7% in first-cannulation group versus 92.0% in first-LAMS group (p = 0.04). The overall endoscopic complication rate was 30.5% in first-cannulation group versus 17.9% in first-LAMS group (p = 0.25). The overall complication rate after PD was higher in the first-cannulation group than in the first-LAMS group (92.2% versus 75.0%, p = 0.016). Overall survival and progression-free survival did not differ between the groups.

Conclusions

PBD with ECE-LAMS is easier to deploy and more efficient than ERCP in patients with DMBO. It is associated with less surgical complications after pancreatoduodenectomy without compromising the oncological outcome.

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Title: Pancreatoduodenectomy Following Preoperative Biliary Drainage Using Endoscopic Ultrasound-Guided Choledochoduodenostomy Versus a Transpapillary Stent: A Multicenter Comparative Cohort Study of the ACHBT–FRENCH–SFED Intergroup
Authors: Julien Janet, MD
Jeremie Albouys, MD
Bertrand Napoleon, MD, PhD
Jeremie Jacques, MD, PhD
Muriel Mathonnet, MD, PhD
Julien Magne, MD, PhD
Marie Fontaine, MD
Charles de Ponthaud, MD
Sylvaine Durand Fontanier, MD
Sylvia S. M. Bardet, PhD
Raphael Bourdariat, MD, PhD
Laurent Sulpice, MD, PhD
Mickael Lesurtel, MD, PhD
Romain Legros, MD
Stephanie Truant, MD, PhD
Fabien Robin, MD, PhD
Frédéric Prat, MD, PhD
Maxime Palazzo, MD, PhD
Lilian Schwarz, MD, PhD
Emmanuel Buc, MD, PhD
Alain Sauvanet, MD, PhD
Sebastien Gaujoux, MD, PhD
Abdelkader Taibi, MD, PhD
Publication date: 17-04-2023
Publisher: Springer International Publishing
Keywords: Ultrasound
Pancreatoduodenostomy
Pancreatoduodenostomy
Ultrasound
Endoscopic Retrograde Cholangiopancreatography
Published in: Annals of Surgical Oncology / Issue 8/2023
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-023-13466-8

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Pancreatoduodenectomy Following Preoperative Biliary Drainage Using Endoscopic Ultrasound-Guided Choledochoduodenostomy Versus a Transpapillary Stent: A Multicenter Comparative Cohort Study of the ACHBT–FRENCH–SFED Intergroup

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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