Endoscopic ultrasound-guided gallbladder drainage as a first approach for jaundice palliation in unresectable malignant distal biliary obstruction: Prospective study.
EC-LAMS
Hot-Spaxus
drainage: EUS-GBD
interventional EUS
malignant biliary obstruction (MBO)
Journal
Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society
ISSN: 1443-1661
Titre abrégé: Dig Endosc
Pays: Australia
ID NLM: 9101419
Informations de publication
Date de publication:
30 May 2023
30 May 2023
Historique:
received:
05
04
2023
accepted:
29
05
2023
pubmed:
30
5
2023
medline:
30
5
2023
entrez:
30
5
2023
Statut:
aheadofprint
Résumé
Endoscopic retrograde cholangiopancreatography (ERCP) represents the gold standard for jaundice palliation in patients with distal malignant biliary obstruction (DMBO). Biliary drainage using electrocautery lumen apposing metal stent (EC-LAMS) is currently a well-established procedure when ERCP fails. In a palliative setting the endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) could represent an easy and valid option. We performed a prospective study with a new EC-LAMS with the primary aim to assess the clinical success rate of EUS-GBD as a first-line approach to the palliation of DMBO. In all, 37 consecutive patients undergoing EUS-GBD with a new EC-LAMS were prospectively enrolled. Clinical success was defined as bilirubin level decrease >15% within 24 h and >50% within 14 days after EC-LAMS placement. The mean age was 73.5 ± 10.8 years; there were 17 male patients (45.9%). EC-LAMS placement was technically feasible in all patients (100%) and the clinical success rate was 100%. Four patients (10.8%) experienced adverse events, one bleeding, one food impaction, and two cystic duct obstructions because of disease progression. No stent-related deaths were observed. The mean hospitalization was 7.7 ± 3.4 days. Median overall survival was 4 months (95% confidence interval 1-8). Endoscopic ultrasound-guided gallbladder drainage with the new EC-LAMS is a valid option in palliative endoscopic biliary drainage as a first-step approach in low survival patients with malignant jaundice unfit for surgery. A smaller diameter EC-LAMS should be preferred, particularly if the drainage is performed through the stomach, to avoid potential food impaction, which could result in stent dysfunction.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© 2023 Japan Gastroenterological Endoscopy Society.
Références
Dumonceau JM, Tringali A, Papanikolaou IS et al. Endoscopic biliary stenting: Indications, choice of stents, and results: European Society of Gastrointestinal Endoscopy (ESGE) clinical guideline - Updated October 2017. Endoscopy 2018; 50: 910-30.
Mangiavillano B, Papanikolaou IS, Arvanitakis M et al. Endoscopic drainage in patients with malignant extrahepatic biliary obstruction: When and how. Eur J Gastroenterol Hepatol 2020; 32: 1279-83.
Enochsson L, Swahn F, Arnelo U, Nilsson M, Löhr 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: 1175-84.
Voegeli DR, Crummy AB, Weese JL. Percutaneous transhepatic cholangiography, drainage, and biopsy in patients with malignant biliary obstruction. An alternative to surgery. Am J Surg 1985; 150: 243-7.
Winick AB, Waybill PN, Venbrux AC. Complications of percutaneous transhepatic biliary interventions. Tech Vasc Interv Radiol 2001; 4: 200-6.
Giovannini M, Moutardier V, Pesenti C, Bories E, Lelong B, Delpero J. Endoscopic ultrasound-guided bilioduodenal anastomosis: A new technique for biliary drainage. Endoscopy 2001; 33: 898-900.
van der Merwe SW, van Wanrooij RLJ, Bronswijk M et al. Therapeutic endoscopic ultrasound: European Society of Gastrointestinal Endoscopy (ESGE) guideline. Endoscopy 2022; 54: 185-205.
Bang JY, Varadarajulu S. Lumen-apposing metal stents for endoscopic ultrasonography-guided interventions. Dig Endosc 2019; 31: 619-26.
Nakai Y, Matsubara S, Isayama H, Koike K. Cystic duct patency in EUS-guided gallbladder drainage as a rescue treatment for malignant biliary obstruction. Gastrointest Endosc 2016; 83: 1302-3.
Minaga K, Takenaka M, Yamao K et al. Clinical utility of treatment method conversion during single-session endoscopic ultrasound-guided biliary drainage. World J Gastroenterol 2020; 26: 947-59.
Podboy A, Yuan J, Stave CD, Chan SM, Hwang JH, Teoh AYB. Comparison of EUS-guided endoscopic transpapillary and percutaneous gallbladder drainage for acute cholecystitis: A systematic review with network meta-analysis. Gastrointest Endosc 2021; 93: 797-804.
Imai H, Kitano M, Omoto S et al. EUS-guided gallbladder drainage for rescue treatment of malignant distal biliary obstruction after unsuccessful ERCP. Gastrointest Endosc 2016; 84: 147-51.
Issa D, Irani S, Law R et al. Endoscopic ultrasound-guided gallbladder drainage as a rescue therapy for unresectable malignant biliary obstruction: A multicenter experience. Endoscopy 2021; 53: 827-31.
Cotton PB, Eisen GM, Aabakken L et al. A lexicon for endoscopic adverse events: Report of an ASGE workshop. Gastrointest Endosc 2010; 71: 446-54.
Nass KJ, Zwager LW, van der Vlugt M et al. Novel classification for adverse events in GI endoscopy: The AGREE classification. Gastrointest Endosc 2022; 95: 1078-85.
Teoh AYB, Napoleon B, Kunda R et al. EUS-guided choledocho-duodenostomy using lumen apposing stent versus ERCP with covered metallic stents in patients with unresectable malignant distal biliary obstruction: A multicenter randomized controlled trial (DRA-MBO trial). Gastroenterology Published online: 28 Apr 2023; DOI: 10.1053/j.gastro.2023.04.016.
Mangiavillano B, Moon JH, Facciorusso A et al. EUS-guided biliary drainage with a novel electrocautery-enhanced lumen apposing metal stent as first approach for distal malignant biliary obstruction: A prospective study. Endosc Int Open 2022; 10: E998-1003.
Facciorusso A, Mangiavillano B, Paduano D et al. Methods for drainage of distal malignant biliary obstruction after ERCP failure: A systematic review and network meta-analysis. Cancers (Basel) 2022; 14: 3291.
Mangiavillano B, Moon JH, Crinò SF et al. Safety and efficacy of a novel electrocautery-enhanced lumen-apposing metal stent in interventional EUS procedures (with video). Gastrointest Endosc 2022; 95: 115-22.
Mangiavillano B, Auriemma F, Lamonaca L, Repici A. A novel lumen-apposing metal stent with an electrocautery tip for different indications: Initial experience in a referral center. Dig Dis 2022; 40: 526-9.
Paduano D, Facciorusso A, De Marco A et al. Endoscopic ultrasound guided biliary drainage in malignant distal biliary obstruction. Cancer 2023; 15: 490.