867c: ENDOSCOPIC ULTRASOUND-GUIDED BILIARY DRAINAGE OF FIRST INTENT WITH A LUMEN-APPOSING METAL STENT VS. ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY IN MALIGNANT DISTAL BILIARY OBSTRUCTION: A MULTICENTER RANDOMIZED CONTROLLED TRIAL (ELEMENT TRIAL)

Chen, Yen-I; Sahai, Anand V.; Donatelli, Gianfranco; Lam, Eric; Forbes, Nauzer; Mosko, Jeffrey D.; Paquin, Sarto C.; Donnellan, Fergal; Chatterjee, Avijit; Telford, Jennifer J.; Miller, Corey; Désilets, Étienne; Sandha, Gurpal; Kenshil, Sana; Mohamed, Rachid; May, Gary R.; Gan, S. Ian; Barkun, Jeffrey; Calo, Natalia Causada; Nawawi, Abrar Y.; Friedman, Gerald; Cohen, Albert; Manière, T; Chaudhury, Prosanto; Metrakos, Peter; Zogopoulos, George; Bessissow, Ali; Khalil, Jad Abou; Baffis, Vicky; Waschke, Kevin; Parent, Josée; Soulellis, Constantine A.; Khashab, Mouen A.; Kunda, Rastislav; Geraci, Olivia; Martel, Myriam; Schwartzman, Kevin; Fiore, Julio F.; Rahme, Elham; Barkun, Alan N.

doi:10.1016/s0016-5085(22)64058-7

Cited by 12 publications

(35 citation statements)

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“…Results indicate that EUS-BD is equally effective but safer in terms of acute and total AEs compared with PTBD. For this indication, a recent multicenter RCT even showed that EUS-CDS of first intent is noninferior to ERCP [8].…”

Section: Choose the Best Alternative Wisely For Biliary Interventions...mentioning

confidence: 99%

Choose the best alternative wisely for biliary interventions after failed ERCP!

Neuhaus

2024

Endosc Int Open

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Section: Choose the Best Alternative Wisely For Biliary Interventions...mentioning

confidence: 99%

Choose the best alternative wisely for biliary interventions after failed ERCP!

Neuhaus

2024

Endosc Int Open

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“…Prevention measures (e.g., prophylactic pancreatic stent, non-steroidal anti-inflammatory drugs, and hydration [31]) can be undertaken for patients who are predicted to be at high risk of developing post-ERCP pancreatitis. In randomised controlled trials of patients with nonresectable distal MBO [32,33], researchers have demonstrated the feasibility of EUS-guided choledochoduodenostomy using a lumen-apposing metal stent with a higher technical success rate and comparable stent patency compared to ERCP-based SEMS placement. During the procedure of EUS-guided drainage, the mechanical burden on the pancreatic ductal system and resultant pancreatic inflammation may be minimised.…”

Section: Accepted Manuscriptmentioning

confidence: 99%

Computed tomography-based prediction of pancreatitis following biliary metal stent placement with the convolutional neural network

Hamada,

Yasaka,

Nakai

et al. 2024

Endosc Int Open

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Introduction: Pancreatitis is a potentially lethal adverse event of endoscopic transpapillary placement of a self-expandable metal stent (SEMS) for malignant biliary obstruction (MBO). Deep learning-based image recognition has not been investigated in predicting pancreatitis in this setting. Methods: We included 70 patients who received endoscopic placement of a SEMS for nonresectable distal MBO. We constructed a convolutional neural network (CNN) model for pancreatitis prediction using a series of preprocedural computed tomography images covering the whole pancreas (≥ 120,960 augmented images in total). We examined the additional effects of the CNN-based probabilities on the following machine learning models based on clinical parameters: logistic regression, support vector machine with a linear or RBF kernel, random forest classifier, and gradient boosting classifier. Model performance was assessed based on the area under the curve (AUC) in the receiver operating characteristic analysis, positive predictive value (PPV), accuracy, and specificity. Results: The CNN model was associated with moderate levels of performance metrics: AUC, 0.67; PPV, 0.45; accuracy, 0.66; and specificity, 0.63. When added to the machine learning models, the CNN-based probabilities increased the performance metrics. The logistic regression model with the CNN-based probabilities had an AUC of 0.74, PPV of 0.85, accuracy of 0.83, and specificity of 0.96, compared to 0.72, 0.78, 0.77, and 0.96, respectively, without the probabilities. Conclusions: The CNN-based model may increase the predictability for pancreatitis following endoscopic placement of a biliary SEMS. Our findings support the potential of deep learning technology in improving prognostic models in pancreatobiliary therapeutic endoscopy.

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“…E NDOSCOPIC ULTRASOUND-GUIDED CHOLEDO-CHODUODENOSTOMY (EUS-CDS) is an established strategy for addressing distal malignant biliary obstruction whenever endoscopic retrograde cholangiopancreatography (ERCP) fails [1][2][3] or as an upfront drainage approach, corroborated by recent randomized data. 4,5 EUS-CDS with electrocautery-enhanced lumen apposing metal stents (LAMS), allowing single-step free-hand access and stent release, has demonstrated excellent technical (93.3-97.8%) and clinical success (91.2-96.2%) with an acceptable safety profile (5.2-27.4%). [4][5][6] However, longterm outcomes have been underreported.…”

Section: Introductionmentioning

confidence: 99%

“…4,5 EUS-CDS with electrocautery-enhanced lumen apposing metal stents (LAMS), allowing single-step free-hand access and stent release, has demonstrated excellent technical (93.3-97.8%) and clinical success (91.2-96.2%) with an acceptable safety profile (5.2-27.4%). [4][5][6] However, longterm outcomes have been underreported. Recent evidence [4][5][6][7][8] has focused on LAMS dysfunctions, reporting a heterogeneous prevalence (8.9-55%).…”

Section: Introductionmentioning

confidence: 99%

Managing dysfunctions and reinterventions in endoscopic ultrasound‐guided choledochoduodenostomy with lumen apposing metal stents: Illustrated technical review (with videos)

Vanella,

Dell'Anna,

van Wanrooij

et al. 2023

Digestive Endoscopy

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Endoscopic ultrasound‐guided choledochoduodenostomy (EUS‐CDS) with lumen apposing metal stent (LAMS) is emerging both as a rescue strategy and a primary treatment for distal malignant biliary obstruction (dMBO). The large‐scale diffusion of the procedure and improved overall survival of patients with pancreatobiliary neoplasms is resulting in a growing population of long‐term EUS‐CDS LAMS carriers.Recent studies have reported a need for reintervention during follow‐up as higher as 55%, and the Leuven‐Amsterdam‐Milan Study Group (L.A.M.S) Classification has been developed, identifying 5 mechanisms of stent dysfunction and 11 possible rescue strategies aimed at restoring biliary drainage.This illustrated technical review aims to further dissect the recent classification through a comprehensive analysis of nine illustrative cases, offering insights into the pathophysiology underlying dysfunction and clinical reasoning behind rescue interventions, as well as technical considerations and practical tips and tricks.By exploring mechanisms of dysfunction, this review also assists clinicians in selecting the ideal candidates for EUS‐CDS while identifying patients deemed high risk for dysfunction or clinical failure.

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867c: ENDOSCOPIC ULTRASOUND-GUIDED BILIARY DRAINAGE OF FIRST INTENT WITH A LUMEN-APPOSING METAL STENT VS. ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY IN MALIGNANT DISTAL BILIARY OBSTRUCTION: A MULTICENTER RANDOMIZED CONTROLLED TRIAL (ELEMENT TRIAL)

Cited by 12 publications

References 0 publications

Choose the best alternative wisely for biliary interventions after failed ERCP!

Choose the best alternative wisely for biliary interventions after failed ERCP!

Computed tomography-based prediction of pancreatitis following biliary metal stent placement with the convolutional neural network

Managing dysfunctions and reinterventions in endoscopic ultrasound‐guided choledochoduodenostomy with lumen apposing metal stents: Illustrated technical review (with videos)

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