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 Study (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, Ian; Barkun, Jeffrey; Calo, Natalia Causada; Nawawi, Abrar; 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:10.1053/j.gastro.2023.07.024

Cited by 46 publications

(33 citation statements)

References 42 publications

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“…16 Conversely, GOO might follow EUS-CDS and should be therefore acknowledged as a possible cause of ascending cholangitis (Fig. 3, item [5]). Gastrointestinal followthrough (sometimes requiring late sequences and/or position changes) can display contrast accumulating in the bulb and refluxing into the CBD via the LAMS.…”

Section: Discussionmentioning

confidence: 99%

“…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%

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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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Section: Discussionmentioning

confidence: 99%

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

View full text Add to dashboard Cite

show abstract

“…14 min vs. ERCP 25 min bzw. 23 min, p = jeweils < 0,01) [28,29]. ▪ Die Rate unerwünschter Ereignisse (AE) nach 30 Tagen (p = 1) und die 30-Tage-Mortalität (p = 0,53) waren zwischen beiden Verfahren vergleichbar [28].…”

Section: Cme-fortbildungunclassified

Transbulbäre und transgastrale Gallengangsdrainage

Thies,

Dollhopf

2024

Gastroenterologie up2date

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“…To conclude, in the context of the current literature on the efficiency and safety of EUS-CD, it is acceptable to propose EUS-CD as the first-line approach for the management of MDBO according to the expertise of the center, but the important risk for stent dysfunction must be considered. In this perspective, two recent randomized series showed noninferior or better results when comparing EUS-CD with ERCP [14,15]. The high rate of stent dysfunction reported in the Fritzsche et al study should prompt the careful follow-up of patients, limiting the indication of EUS-CD to patients with a CBD diameter of >15 mm, and avoiding cases of duodenal invasion.…”

mentioning

confidence: 98%

Endoscopic ultrasound-guided choledochoduodenostomy: is the rate of stent dysfunction underestimated?

Barthet

2023

Endoscopy

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In this issue of Endoscopy, Fritzsche et al. from Amsterdam present the results of their prospective study on endoscopic ultrasound-guided choledochoduodenostomy (EUS-CD) for the primary drainage of malignant distal biliary obstruction (MDBO) (SCORPION-p study) [1]. The authors reported very high technical and clinical success rates of 91% and 86%, respectively, which are comparable to those reported in the literature [2]. In a recent multicenter series with EUS-CD performed in patients with endoscopic retrograde cholangiopancreatography (ERCP) failure, the results were the same, with 92% and 86% technical and clinical success rates, respectively [3]. These rates were also confirmed in another systematic review and metaanalysis including lumen-apposing metal stents (LAMS) and self-expandable metal stents (SEMS), with technical and clinical success rates of 94.8% and 93.6%, respectively [4]. Therefore, the efficacy of EUS-CD is about 90% or more in the literature and the discussion should be focused on adverse events or recurrent jaundice, which have been reported to be 5.6% and 11.3%, respectively [5].In the Fritzsche et al. study, the authors did not report immediate procedural or periprocedural adverse events, showing that in expert centers, EUS-CD could be safe. In contrast, the authors found an unusually high rate of stent dysfunction (55%) when they followed the patients for at least 6 months, this rate being much higher than that reported in the literature (6%-37%). This is probably the feeling of many operators in real life. Thus, we should be mindful of the risk factors for stent dysfunction as well as strategies to prevent stent dysfunction."The high rate of stent dysfunction reported in this study should prompt the careful follow-up of patients, limiting the indication of EUS-CD to patients with a common bile duct diameter of >15 mm, and avoiding cases of duodenal invasion."The frequency, risk factors, classification, and prevention of stent dysfunction reported in the literature are controversial [2,6,7]. The results of 155 studies on EUS-guided biliary drainage found rates of stent migration or occlusion of 1.7% and 11%, respectively [6]. The reintervention rate was 16.2%, which is perhaps more representative of the overall rate of stent dysfunction [6]. Risk factors were assessed in a prospective singlecenter study in patients undergoing EUS-CD, more than 75% of Endoscopic ultrasound-guided choledochoduodenostomy: is the rate of stent dysfunction underestimated?Referring to Fritzsche JA et al.

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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 Study (ELEMENT Trial)

Cited by 46 publications

References 42 publications

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

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

Transbulbäre und transgastrale Gallengangsdrainage

Endoscopic ultrasound-guided choledochoduodenostomy: is the rate of stent dysfunction underestimated?

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