EUS-guided biliary drainage with LAMS for distal malignant biliary obstruction when ERCP fails: single-center retrospective study and maldeployment management.
Cholangiopancreatography, Endoscopic Retrograde
/ adverse effects
Cholestasis
/ etiology
Drainage
/ adverse effects
Endosonography
/ adverse effects
Gastric Outlet Obstruction
/ etiology
Humans
Neoplasms
/ complications
Retrospective Studies
Stents
/ adverse effects
Ultrasonography, Interventional
/ adverse effects
Distal malignant biliary obstruction (D-MBO)
ERCP
EUS-guided biliary drainage
Lumen apposing metal stent (LAMS)
Maldeployment
Journal
Surgical endoscopy
ISSN: 1432-2218
Titre abrégé: Surg Endosc
Pays: Germany
ID NLM: 8806653
Informations de publication
Date de publication:
06 2022
06 2022
Historique:
received:
01
05
2021
accepted:
17
10
2021
pubmed:
2
11
2021
medline:
14
5
2022
entrez:
1
11
2021
Statut:
ppublish
Résumé
EUS-guided biliary drainage (EUS-BD) with Lumen Apposing Metal Stent (LAMS) is a mini-invasive approach for jaundice palliation in distal malignant biliary obstruction (D-MBO) not amenable to ERCP, with good efficacy and not exiguous adverse events. From January 2015 to December 2019, we retrospectively enrolled all the EUS-BD with electrocautery-enhanced LAMS for biliary decompression in unresectable D-MBO and failed ERCP. Primary study aims were to evaluate technical/clinical success and AEs rate. In case of maldeployment, we estimated the efficacy of an intra-operative rescue therapy. Secondary aims were to assess the jaundice recurrence and gastric outlet obstruction symptoms. Thirty-six EUS-BD were enrolled over a cohort of 738 patients (ERCP cannulation failure rate was 2.6%): 31 choledocho-duodenostomy and 5 cholecystogastrostomy. A pre-loaded guidewire through the LAMS was systematically used in case of common bile duct ≤ 15 mm or scope instability for a safe/preventive biliary entryway in case of intra-procedural complications. Technical success was 80.6% (29/36 patients). Seven cases of LAMS maldeployment during EUS-guided choledocho-duodenostomy were successfully treated with RT by an over-the-wire fully-covered Self-Expandable Metal Stent (FC-SEMS). The FC-SEMS was released through the novel fistula tract in endoscopic fashion in 5/7 cases and transpapillary in percutaneous-transhepatic-endoscopic rendezvous (1/7) and laparoscopic-endoscopic rendezvous (1/7) in the two remaining cases. The total efficacy of rescue therapy was 100%. Same-session duodenal SEMS was placed in 17 patients with optimal gastric outlet obstruction management. Final clinical success was 100% and no other late adverse events or FC-SEMS migration were observed. EUS-BD with LAMS is effective for jaundice palliation after ERCP failure but with considerable adverse events. Maldeployment remains a serious complication with fatal evolution if not correctly recognized/managed. Rescue therapy must be promptly applied especially in tertiary-care centers with highly skilled endoscopists, interventional radiologist and dedicated surgeon.
Sections du résumé
BACKGROUND
EUS-guided biliary drainage (EUS-BD) with Lumen Apposing Metal Stent (LAMS) is a mini-invasive approach for jaundice palliation in distal malignant biliary obstruction (D-MBO) not amenable to ERCP, with good efficacy and not exiguous adverse events.
AIMS AND METHODS
From January 2015 to December 2019, we retrospectively enrolled all the EUS-BD with electrocautery-enhanced LAMS for biliary decompression in unresectable D-MBO and failed ERCP. Primary study aims were to evaluate technical/clinical success and AEs rate. In case of maldeployment, we estimated the efficacy of an intra-operative rescue therapy. Secondary aims were to assess the jaundice recurrence and gastric outlet obstruction symptoms.
RESULTS
Thirty-six EUS-BD were enrolled over a cohort of 738 patients (ERCP cannulation failure rate was 2.6%): 31 choledocho-duodenostomy and 5 cholecystogastrostomy. A pre-loaded guidewire through the LAMS was systematically used in case of common bile duct ≤ 15 mm or scope instability for a safe/preventive biliary entryway in case of intra-procedural complications. Technical success was 80.6% (29/36 patients). Seven cases of LAMS maldeployment during EUS-guided choledocho-duodenostomy were successfully treated with RT by an over-the-wire fully-covered Self-Expandable Metal Stent (FC-SEMS). The FC-SEMS was released through the novel fistula tract in endoscopic fashion in 5/7 cases and transpapillary in percutaneous-transhepatic-endoscopic rendezvous (1/7) and laparoscopic-endoscopic rendezvous (1/7) in the two remaining cases. The total efficacy of rescue therapy was 100%. Same-session duodenal SEMS was placed in 17 patients with optimal gastric outlet obstruction management. Final clinical success was 100% and no other late adverse events or FC-SEMS migration were observed.
CONCLUSION
EUS-BD with LAMS is effective for jaundice palliation after ERCP failure but with considerable adverse events. Maldeployment remains a serious complication with fatal evolution if not correctly recognized/managed. Rescue therapy must be promptly applied especially in tertiary-care centers with highly skilled endoscopists, interventional radiologist and dedicated surgeon.
Identifiants
pubmed: 34724586
doi: 10.1007/s00464-021-08808-0
pii: 10.1007/s00464-021-08808-0
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
4553-4569Informations de copyright
© 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.
Références
Huguier M, Baumel H, Manderscheid JC, Houry S, Fabre JM (1993) Surgical palliation for unresected cancer of the exocrine pancreas. Eur J Surg Oncol 19(4):342–347
pubmed: 7689488
Topazian M, Ring E, Grendell J (1992) Palliation of obstructing gastric cancer with steel mesh, self-expanding endoprostheses. Gastrointest Endosc 38(1):58–60
pubmed: 1377147
doi: 10.1016/S0016-5107(92)70334-4
Park CH, Park JC, Kim EH, Chung H, An JY, Kim HI et al (2015) Impact of carcinomatosis and ascites status on long-term outcomes of palliative treatment for patients with gastric outlet obstruction caused by unresectable gastric cancer: stent placement versus palliative gastrojejunostomy. Gastrointest Endosc 81(2):321–332
pubmed: 25085332
doi: 10.1016/j.gie.2014.06.024
No JH, Kim SW, Lim CH, Kim JS, Cho YK, Park JM et al (2013) Long-term outcome of palliative therapy for gastric outlet obstruction caused by unresectable gastric cancer in patients with good performance status: endoscopic stenting versus surgery. Gastrointest Endosc 78(1):55–62
pubmed: 23522025
doi: 10.1016/j.gie.2013.01.041
Jang SH, Lee H, Min BH, Kim SM, Kim HS, Carriere KC et al (2017) Palliative gastrojejunostomy versus endoscopic stent placement for gastric outlet obstruction in patients with unresectable gastric cancer: a propensity score-matched analysis. Surg Endosc 31(10):4217–4223
pubmed: 28281127
doi: 10.1007/s00464-017-5480-6
Roy A, Kim M, Christein J, Varadarajulu S (2012) Stenting versus gastrojejunostomy for management of malignant gastric outlet obstruction: comparison of clinical outcomes and costs. Surg Endosc 26(11):3114–3119
pubmed: 22549377
pmcid: 3472065
doi: 10.1007/s00464-012-2301-9
Maetani I, Tada T, Ukita T, Inoue H, Sakai Y, Nagao J (2004) Comparison of duodenal stent placement with surgical gastrojejunostomy for palliation in patients with duodenal obstructions caused by pancreaticobiliary malignancies. Endoscopy 36(1):73–78
pubmed: 14722859
doi: 10.1055/s-2004-814123
Adler DG, Baron TH, Davila RE, Egan J, Hirota WK, Leighton JA et al (2005) ASGE guideline: the role of ERCP in diseases of the biliary tract and the pancreas. Gastrointest Endosc 62(1):1–8
pubmed: 15990812
doi: 10.1016/j.gie.2005.04.015
Martin DF (1994) Combined percutaneous and endoscopic procedures for bile duct obstruction. Gut 35(8):1011–1012
pubmed: 7926895
pmcid: 1375043
doi: 10.1136/gut.35.8.1011
Tarantino I, Barresi L, Fabbri C, Traina M (2012) Endoscopic ultrasound guided biliary drainage. World J Gastrointest Endosc 4(7):306–311
pubmed: 22816011
pmcid: 3399009
doi: 10.4253/wjge.v4.i7.306
Peng C, Nietert PJ, Cotton PB, Lackland DT, Romagnuolo J (2013) Predicting native papilla biliary cannulation success using a multinational endoscopic retrograde cholangiopancreatography (ERCP) quality network. BMC Gastroenterol 13:147
pubmed: 24112846
pmcid: 3882886
doi: 10.1186/1471-230X-13-147
Holt BA, Hawes R, Hasan M, Canipe A, Tharian B, Navaneethan U et al (2016) Biliary drainage: role of EUS guidance. Gastrointest Endosc 83(1):160–165
pubmed: 26215648
doi: 10.1016/j.gie.2015.06.019
Dhir V, Isayama H, Itoi T, Almadi M, Siripun A, Teoh AYB et al (2017) Endoscopic ultrasonography-guided biliary and pancreatic duct interventions. Dig Endosc 29(4):472–485
pubmed: 28118509
doi: 10.1111/den.12818
Williams EJ, Ogollah R, Thomas P, Logan RF, Martin D, Wilkinson ML et al (2012) What predicts failed cannulation and therapy at ERCP? Results of a large-scale multicenter analysis. Endoscopy 44(7):674–683
pubmed: 22696192
doi: 10.1055/s-0032-1309345
Law R, Baron TH (2016) Endoscopic ultrasound-guided biliary interventions: an update on recent developments. Curr Opin Gastroenterol 32(3):232–237
pubmed: 26959514
Bang JY, Navaneethan U, Hasan M, Hawes R, Varadarajulu S (2018) Stent placement by EUS or ERCP for primary biliary decompression in pancreatic cancer: a randomized trial (with videos). Gastrointest Endosc 88(1):9–17
pubmed: 29574126
doi: 10.1016/j.gie.2018.03.012
Leng JJ, Zhang N, Dong JH (2014) Percutaneous transhepatic and endoscopic biliary drainage for malignant biliary tract obstruction: a meta-analysis. World J Surg Oncol 12(1):272
pubmed: 25148939
pmcid: 6389255
doi: 10.1186/1477-7819-12-272
Giovannini M, Moutardier V, Pesenti C, Bories E, Lelong B, Delpero JR (2001) Endoscopic ultrasound-guided bilioduodenal anastomosis: a new technique for biliary drainage. Endoscopy 33(10):898–900
pubmed: 11571690
doi: 10.1055/s-2001-17324
Itoi T, Binmoeller KF (2014) EUS-guided choledochoduodenostomy by using a biflanged lumen-apposing metal stent. Gastrointest Endosc 79(5):715
pubmed: 24424399
doi: 10.1016/j.gie.2013.11.021
Anderloni A, Attili F, Carrara S, Galasso D, Di Leo M, Costamagna G et al (2017) Intra-channel stent release technique for fluoroless endoscopic ultrasound-guided lumen-apposing metal stent placement: changing the paradigm. Endosc Int Open 5(1):E25–E29
pubmed: 28337480
pmcid: 5361875
doi: 10.1055/s-0042-122009
Salerno R, Davies SEC, Mezzina N, Ardizzone S (2019) Comprehensive review on EUS-guided biliary drainage. World J Gastrointest Endosc 11(5):354–364
pubmed: 31205596
pmcid: 6556484
doi: 10.4253/wjge.v11.i5.354
Paik WH, Lee TH, Park DH, Choi JH, Kim SO, Jang S et al (2018) EUS-guided biliary drainage versus ERCP for the primary palliation of malignant biliary obstruction: a multicenter randomized clinical trial. Am J Gastroenterol 113(7):987–997
pubmed: 29961772
doi: 10.1038/s41395-018-0122-8
Bang JY, Varadarajulu S (2019) Lumen-apposing metal stents for endoscopic ultrasonography-guided interventions. Dig Endosc 31(6):619–626
pubmed: 31050068
doi: 10.1111/den.13428
Bang JY, Navaneethan U, Hasan MK, Sutton B, Hawes R, Varadarajulu S (2019) Non-superiority of lumen-apposing metal stents over plastic stents for drainage of walled-off necrosis in a randomised trial. Gut 68(7):1200–1209
pubmed: 29858393
doi: 10.1136/gutjnl-2017-315335
Issa D, Irani S, Law R, Shah S, Bhalla S, Mahadev S et al (2020) Endoscopic ultrasound-guided gallbladder drainage as a rescue therapy for unresectable malignant biliary obstruction: a multicenter experience. Endoscopy. https://doi.org/10.1055/a-1259-0349
doi: 10.1055/a-1259-0349
pubmed: 32898918
Adler DG, Baron TH (2002) Endoscopic palliation of malignant gastric outlet obstruction using self-expanding metal stents: experience in 36 patients. Am J Gastroenterol 97(1):72–78
pubmed: 11808972
doi: 10.1111/j.1572-0241.2002.05423.x
Mutignani M, Tringali A, Shah SG, Perri V, Familiari P, Iacopini F et al (2007) Combined endoscopic stent insertion in malignant biliary and duodenal obstruction. Endoscopy 39(5):440–447
pubmed: 17516351
doi: 10.1055/s-2007-966327
Abud A, Keswani RN (2021) You can go your own way: EUS-guided lumen-apposing metal stent as a rescue for failed ERCP. Gastrointest Endosc 94(2):329–332
pubmed: 34023066
doi: 10.1016/j.gie.2021.03.011
Dhindsa BS, Mashiana HS, Dhaliwal A, Mohan BP, Jayaraj M, Sayles H et al (2020) EUS-guided biliary drainage: a systematic review and meta-analysis. Endosc Ultrasound 9(2):101–109
pubmed: 32295967
pmcid: 7279084
doi: 10.4103/eus.eus_80_19
Amato A, Sinagra E, Celsa C, Enea M, Buda A, Vieceli F et al (2020) Efficacy and safety of lumen apposing metal stents or self-expandable metal stents for endoscopic ultrasound-guided choledocho-duodenostomy: a systematic review and meta-analysis. Endoscopy. https://doi.org/10.1055/a-1324-7919
doi: 10.1055/a-1324-7919
pubmed: 33246343
Khashab MA, Valeshabad AK, Afghani E, Singh VK, Kumbhari V, Messallam A et al (2015) A comparative evaluation of EUS-guided biliary drainage and percutaneous drainage in patients with distal malignant biliary obstruction and failed ERCP. Dig Dis Sci 60(2):557–565
pubmed: 25081224
doi: 10.1007/s10620-014-3300-6
Kunda R, Pérez-Miranda M, Will U, Ullrich S, Brenke D, Dollhopf M et al (2016) EUS-guided choledochoduodenostomy for malignant distal biliary obstruction using a lumen-apposing fully covered metal stent after failed ERCP. Surg Endosc 30(11):5002–5008
pubmed: 26969661
doi: 10.1007/s00464-016-4845-6
Tsuchiya T, Teoh AYB, Itoi T, Yamao K, Hara K, Nakai Y et al (2018) Long-term outcomes of EUS-guided choledochoduodenostomy using a lumen-apposing metal stent for malignant distal biliary obstruction: a prospective multicenter study. Gastrointest Endosc 87(4):1138–1146
pubmed: 28843583
doi: 10.1016/j.gie.2017.08.017
Anderloni A, Fugazza A, Troncone E, Auriemma F, Carrara S, Semeraro R et al (2019) Single-stage EUS-guided choledochoduodenostomy using a lumen-apposing metal stent for malignant distal biliary obstruction. Gastrointest Endosc 89(1):69–76
pubmed: 30189198
doi: 10.1016/j.gie.2018.08.047
Jacques J, Privat J, Pinard F, Fumex F, Valats JC, Chaoui A et al (2019) Endoscopic ultrasound-guided choledochoduodenostomy with electrocautery-enhanced lumen-apposing stents: a retrospective analysis. Endoscopy 51(6):540–547
pubmed: 30347424
doi: 10.1055/a-0735-9137
El Chafic AH, Shah JN, Hamerski C, Binmoeller KF, Irani S, James TW et al (2019) EUS-guided choledochoduodenostomy for distal malignant biliary obstruction using electrocautery-enhanced lumen-apposing metal stents: first US, multicenter experience. Dig Dis Sci 64(11):3321–3327
pubmed: 31175495
doi: 10.1007/s10620-019-05688-2
Kuraoka N, Hara K, Okuno N, Kuwahara T, Mizuno N, Shimizu Y et al (2020) Outcomes of EUS-guided choledochoduodenostomy as primary drainage for distal biliary obstruction with covered self-expandable metallic stents. Endosc Int Open 8(7):E861–E868
pubmed: 32617390
pmcid: 7297614
doi: 10.1055/a-1161-8488
Teoh AYB, Kongkam P, Bapaye A, Ratanachu T, Reknimitr R, Lakthakia S et al (2020) The 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. https://doi.org/10.1111/den.13911
doi: 10.1111/den.13911
pubmed: 31343773
Tarantino I, Peralta M, Ligresti D, Amata M, Barresi L, Cipolletta F et al (2021) Endoscopic ultrasound-guided biliary drainage of malignant stenosis, not treatable with endoscopic retrograde cholangiopancreatography: a single-center, prospective observational study. Endosc Int Open 9(2):E110–E115
pubmed: 33532546
pmcid: 7834702
doi: 10.1055/a-1313-6850
Venkatachalapathy SV, James MW, Huggett MT, Paranandi B, Pereira SP, Johnson G et al (2021) Utility of palliative EUS-guided biliary drainage using lumen-apposing metal stents: a prospective multicenter feasibility study (with video). Gastrointest Endosc 94(2):321–328
pubmed: 33545136
doi: 10.1016/j.gie.2021.01.029
Ligresti D, Amata M, Granata A, Cipolletta F, Barresi L, Traina M et al (2018) Salvage procedure following lumen-apposing metal stent maldeployment during endoscopic ultrasound-guided biliary drainage. Endoscopy 50(7):E190–E191
pubmed: 29895062
doi: 10.1055/a-0605-3198
Fugazza A, Gabbiadini R, Colombo M, Carrara S, Maselli R, Repici A et al (2020) Self-expandable metal stent placement as a rescue procedure for lumen-apposing metal stent misdeployment in biliary drainage. Endoscopy 52(12):E430–E431
pubmed: 32375187
doi: 10.1055/a-1158-8749
Anderloni A, Troncone E, Fugazza A, Cappello A, Blanco GDV, Monteleone G et al (2019) Lumen-apposing metal stents for malignant biliary obstruction: is this the ultimate horizon of our experience? World J Gastroenterol 25(29):3857–3869
pubmed: 31413524
pmcid: 6689812
doi: 10.3748/wjg.v25.i29.3857
Lera ME, Matuguma SE, Madruga-Neto AC, Brunaldi VO, Minata MK, Guedes HG et al (2019) Self-expandable metal stent in lumen-apposing metal stent (the SEMS-in-LAMS procedure): a simple salvage procedure after LAMS misplacement. Endoscopy 51(4):E77–E78
pubmed: 30674045
doi: 10.1055/a-0820-1456
Canakis A, Baron TH (2020) Relief of biliary obstruction: choosing between endoscopic ultrasound and endoscopic retrograde cholangiopancreatography. BMJ Open Gastroenterol 7(1):e000428
pubmed: 32727716
pmcid: 7394303
doi: 10.1136/bmjgast-2020-000428
Adler DG, Lieb JG, Cohen J, Pike IM, Park WG, Rizk MK et al (2015) Quality indicators for ERCP. Gastrointest Endosc 81(1):54–66
pubmed: 25480099
doi: 10.1016/j.gie.2014.07.056
Zulli C, Dumont JL, Cereatti F, Ceci V, Tuszynski T, Fazi M et al (2020) Rescue ERCP after delayed migration of a lumen-apposing metal stent following endoscopic ultrasound-guided choledochoduodenostomy. Endoscopy 52(6):E215–E216
pubmed: 31863439
doi: 10.1055/a-1073-7317
Kakked G, Salameh H, Cheesman AR, Kumta NA, Nagula S, DiMaio CJ (2020) Primary EUS-guided biliary drainage. Endosc Ultrasound 9(5):298–307
pubmed: 32655080
pmcid: 7811719
doi: 10.4103/eus.eus_10_20
Saxena P, Khashab MA (2018) First-line EUS-guided biliary drainage or ERCP in patients with biliary obstruction and in situ duodenal stent? Gastrointest Endosc 88(1):76–78
pubmed: 29935629
doi: 10.1016/j.gie.2018.04.2339