Double EUS bypass: same sequence, different reasons

Bronswijk, Michiel; Vanella, Giuseppe; Merwe, Schalk van der

doi:10.1016/j.vgie.2021.01.008

Cited by 4 publications

(9 citation statements)

References 4 publications

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“…In all cases, EUS-GE will be performed first, as the success of EUS-guided biliary drainage depends on resolving the gastric outlet obstruction. 23 To our best knowledge, this is the largest study exploring the issue of endoscopic management of both biliary and gastric outlet obstruction, the first evaluating and comparing all possible management combinations, and the only reporting on EUS-GE+EUS-CDS.While tertiary referral centers are increasingly replacing ES with EUS-GE, the type of EUS-BD in the context of GOO should be further explored in well-designed prospective clinical studies.…”

Section: Discussionmentioning

confidence: 97%

“…In all cases, EUS‐GE will be performed first, as the success of EUS‐guided biliary drainage depends on resolving the gastric outlet obstruction. 23 …”

Section: Discussionmentioning

confidence: 99%

“…21,22 In addition, EUS-BD will only be successful once GOO has been fully resolved. 23 EUS has revolutionized the endoscopic management of simultaneous biliary and GOO. However, limited non-comparative series have mainly evaluated either individual procedures or single specific combinations in double obstruction.…”

Section: Discussionmentioning

confidence: 99%

“…Our results have discouraged us from using EUS‐CDS in the context of GOO, even when resolved by EUS‐GE, especially in type III duodenal stenosis. In all cases, EUS‐GE will be performed first, as the success of EUS‐guided biliary drainage depends on resolving the gastric outlet obstruction 23 …”

Section: Discussionmentioning

confidence: 99%

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Combined endoscopic mAnagement of BiliaRy and gastrIc OutLET obstruction (CABRIOLET Study): A multicenter retrospective analysis

et al. 2022

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Objectives Combined biliary obstruction and gastric outlet obstruction (GOO) represent a challenging clinical scenario despite developments in therapeutic endoscopic ultrasonography (EUS) as GOO might impair EUS‐guided biliary drainage. Little is known about the effectiveness of different therapeutic combinations used to treat double obstruction, especially regarding stent patency. Methods All consecutive patients with double obstruction treated between 2016 and 2021 in three tertiary academic centres were eligible for inclusion. Five combinations involving enteral stenting (ES), EUS‐guided gastroenterostomy (EUS‐GE), hepaticogastrostomy (EUS‐HGS), choledochoduodenostomy (EUS‐CDS), and transpapillary biliary stenting (TPS) were evaluated for dysfunction during follow‐up, either as proportions or dysfunction‐free survival (DFS) using Kaplan–Meier estimates. Results Ninety‐three patients were included (male 46%; age 67 [interquartile range 60–76] years; pancreatic cancer 73%, metastatic 57%), resulting in 103 procedure combinations. Different combinations showed significantly different overall dysfunction rates ( p = 0.009), ranging from the null rate of EUS‐GE+HG to the 18% rate of EUS‐GE+TPS, 31% of EUS‐GE+EUS‐CD, 53% of ES+TPS and 83% of ES+EUS‐CDS. Sub‐analyses restricted to biliary dysfunction confirmed these trends. A multivariate Cox proportional‐hazards regression of DFS, a stenosis distal to the papilla (HR 3.2 [1.5–6.9]) and ES+EUS‐CDS (HR 5.6 [2–15.7]) independently predicted dysfunction. Conclusions Despite a lack of statistical power per combination, this study introduces new associations beyond the increased risk of GOO recurrence with ES versus EUS‐GE. EUS‐CDS showed reduced effectiveness and frequent dysfunction in the context of GOO, especially when combined with ES. EUS‐GE+HGS or EUS‐GE+TPS in this setting might result in superior patency. These results suggest that a prospective evaluation of the optimal endoscopic approach to malignant double obstruction is needed.

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Section: Discussionmentioning

confidence: 97%

“…In all cases, EUS‐GE will be performed first, as the success of EUS‐guided biliary drainage depends on resolving the gastric outlet obstruction. 23 …”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Combined endoscopic mAnagement of BiliaRy and gastrIc OutLET obstruction (CABRIOLET Study): A multicenter retrospective analysis

et al. 2022

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“…EUS-GJ must be performed first, as an effective gastroenteric conduit is fundamental for successful transluminal biliary drainage. Conversely, if EUS-GJ proves technically unfeasible, a correctly placed EUS-CD may be rendered dysfunctional, resulting in subsequent cholangitis[ 25 ].…”

Section: Endoscopic Tricks For Eus-guided Procedures In Potentially R...mentioning

confidence: 99%

Feasibility of therapeutic endoscopic ultrasound in the bridge-to-surgery scenario: The example of pancreatic adenocarcinoma

Vanella¹,

Tamburrino²,

Capurso³

et al. 2022

WJG

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Upfront resection is becoming a rarer indication for pancreatic ductal adenocarcinoma, as biologic behavior and natural history of the disease has boosted indications for neoadjuvant treatments. Jaundice, gastric outlet obstruction and acute cholecystitis can frequently complicate this window of opportunity, resulting in potentially deleterious chemotherapy discontinuation, whose resumption relies on effective, prompt and long-lasting management of these complications. Although therapeutic endoscopic ultrasound (t-EUS) can potentially offer some advantages over comparators, its use in potentially resectable patients is primal and has unfairly been restricted for fear of potential technical difficulties during subsequent surgery. This is a narrative review of available evidence regarding EUS-guided choledochoduodenostomy, gastrojejunostomy and gallbladder drainage in the bridge-to-surgery scenario. Proof-of-concept evidence suggests no influence of t-EUS procedures on outcomes of eventual subsequent surgery. Moreover, the very high efficacy-invasiveness ratio over comparators in managing pancreatic cancer-related symptoms or complications can provide a powerful weapon against chemotherapy discontinuation, potentially resulting in higher subsequent resectability. Available evidence is discussed in this short paper, together with technical notes that might be useful for endoscopists and surgeons operating in this scenario. No published evidence supports restricting t-EUS in potential surgical candidates, especially in the setting of pancreatic cancer patients undergoing neoadjuvant chemotherapy. Bridge-to-surgery t-EUS deserves further prospective evaluation.

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Same-session double EUS-guided bypass versus surgical gastroenterostomy and hepaticojejunostomy: an international multicenter comparison

Bronswijk¹,

Vanella²,

Wanrooij³

et al. 2023

Gastrointestinal Endoscopy

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Double EUS bypass: same sequence, different reasons

Cited by 4 publications

References 4 publications

Combined endoscopic mAnagement of BiliaRy and gastrIc OutLET obstruction (CABRIOLET Study): A multicenter retrospective analysis

Combined endoscopic mAnagement of BiliaRy and gastrIc OutLET obstruction (CABRIOLET Study): A multicenter retrospective analysis

Feasibility of therapeutic endoscopic ultrasound in the bridge-to-surgery scenario: The example of pancreatic adenocarcinoma

Same-session double EUS-guided bypass versus surgical gastroenterostomy and hepaticojejunostomy: an international multicenter comparison

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