Pancreatoduodenectomy Following Preoperative Biliary Drainage Using Endoscopic Ultrasound-Guided Choledochoduodenostomy Versus a Transpapillary Stent: A Multicenter Comparative Cohort Study of the ACHBT–FRENCH–SFED Intergroup

Janet, Julien; Albouys, Jérémie; Napoléon, Bertrand; Jacques, Jérémie; Mathonnet, Muriel; Magné, Julien; Fontaine, Marie Madeleine; Ponthaud, Charles de; Fontanier, Sylvaine Durand; Bardet, Sylvia S. M.; Bourdariat, Raphaël; Sulpice, Laurent; Lesurtel, Mickaël; Legros, Romain; Truant, Stéphanie; Robin, Fabien; Prat, Frédéric; Palazzo, Maxime; Schwarz, L.; Buc, Emmanuel; Sauvanet, Alain; Gaujoux, Sébastien; Taïbi, Abdelkader

doi:10.1245/s10434-023-13466-8

Cited by 15 publications

(7 citation statements)

References 32 publications

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“…On the other hand, the fact that five patients underwent surgical resection after a median of 34 days could have led to an underestimation; however, considering stent dysfunction occurred after a median of 6 days, this factor is expected to be of limited influence. Data on surgical resection after EUS-CDS are still scarce; however, we believe the available data show no reason to be reluctant to perform EUS-CDS in operable patients while awaiting further studies in this specific patient group [20].…”

Section: Discussionmentioning

confidence: 92%

“…Data on surgical resection after EUS-CDS is still scarce however we believe the available data shows no reason to be reluctant with EUS-CDS in operable patients while awaiting further studies in this specific patient category. [19] Although the rate of cholangitis due to stent dysfunction was high, the course of the disease was generally mild. The vast majority of patients were successfully treated with antibiotics and/or endoscopic re-intervention.…”

Section: Accepted Manuscriptmentioning

confidence: 99%

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Endoscopic ultrasound-guided choledochoduodenostomy using single-step lumen-apposing metal stents for primary drainage of malignant distal biliary obstruction (SCORPION-p): a prospective pilot study

et al. 2023

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Background and study aims: To assess the safety and feasibility of EUS-guided choledochoduodenostomy (EUS-CDS) using lumen-apposing metal stents (LAMS) as primary drainage strategy in patients with distal malignant biliary obstruction (MBO). Patients and methods: Prospective single center pilot study in patients with a pathology confirmed MBO without gastric-outlet obstruction. Primary outcome was technical success. Secondary outcomes included clinical success, adverse events (AEs) and re-interventions. The study was registered in the Netherlands Trial Registry (registry number NL9757). Results: Overall, 22 patients were enrolled (median age 69.5 years [IQR 64-75.2]. Technical success was achieved in 20/22 patients (91%). Adverse events occurred in one patient, namely a perforation occurred due to inadequate deployment (5%), treated in the same procedure. Clinical success was achieved in 19/22 patients (86%). Stent dysfunction was observed in 11 of the 20 patients after technically successful EUS-CDS (55%). Two patients were treated conservatively, in 9 patients re-intervention(s) were performed. One patient died <30 days due to fulminant disease progression. Conclusions: This study confirms safety and feasibility of EUS-CDS using LAMS as the primary drainage strategy. The high incidence of stent dysfunction should be improved before EUS-CDS with LAMS can be seen as a valid alternative to ERCP.

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Section: Discussionmentioning

confidence: 92%

Section: Accepted Manuscriptmentioning

confidence: 99%

Endoscopic ultrasound-guided choledochoduodenostomy using single-step lumen-apposing metal stents for primary drainage of malignant distal biliary obstruction (SCORPION-p): a prospective pilot study

et al. 2023

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“…There is increasing evidence that EUS-BD does not hinder subsequent pancreaticoduodenectomy, although this only applies to EUS-CDD as the choledochoduodenostomy tract and stent lies within the surgical resection field. This has been demonstrated by several studies ( 30 , 32 , 49 , 62 , 63 ).. Janet, et al. also included a comparator cohort group of patients who underwent ERCP and demonstrated a lower rate of post-operative complications in patients who had EUS-CDD (77.3% vs 93.7%, p=0.01) but no differences in the R0 resection rates, overall survival and progression free survival rates between both groups ( 63 ).…”

Section: Eus-guided Interventions In Pancreatic Cancermentioning

confidence: 83%

“…This has been demonstrated by several studies ( 30 , 32 , 49 , 62 , 63 ).. Janet, et al. also included a comparator cohort group of patients who underwent ERCP and demonstrated a lower rate of post-operative complications in patients who had EUS-CDD (77.3% vs 93.7%, p=0.01) but no differences in the R0 resection rates, overall survival and progression free survival rates between both groups ( 63 ). With the caveat that this was a retrospective study, it adds to the body of evidence supporting EUS-CDD as a viable modality of biliary drainage in patients with operable disease, and instill the confidence in developing future RCTs comparing EUS-CDD against ERCP as a primary modality of biliary decompression in patients with resectable disease.…”

Section: Eus-guided Interventions In Pancreatic Cancermentioning

confidence: 83%

Utility of interventional endoscopic ultrasound in pancreatic cancer

On,

Ahmed,

Everett

et al. 2023

Front. Oncol.

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Endoscopic ultrasound (EUS) has an important role in the management algorithm of patients with pancreatic ductal adenocarcinoma (PDAC), typically for its diagnostic utilities. The past two decades have seen a rapid expansion of the therapeutic capabilities of EUS. Interventional EUS is now one of the more exciting developments within the field of endoscopy. The local effects of PDAC tend to be in anatomical areas which are difficult to target and endoscopy has cemented itself as a key role in managing the clinical sequelae of PDAC. Interventional EUS is increasingly utilized in situations whereby conventional endoscopy is either impossible to perform or unsuccessful. It also adds a different dimension to the host of oncological and surgical treatments for patients with PDAC. In this review, we aim to summarize the various ways in which interventional EUS could benefit patients with PDAC and aim to provide a balanced commentary on the current evidence of interventional EUS in the literature.

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“…Additionally, patients who received EUS-guided biliary drainage had lower rates of reintervention before surgery (9% vs. 38%) compared to ERCP. Similarly, a retrospective multicenter study ( n = 156, 53.8% PDAC) from Europe compared biliary drainage via EUS-CD using a LAMS with SEMS placement via ERCP [ 67 ]. All patients successfully went on to receive the Whipple procedure.…”

Section: Impact Of Therapeutic Eus On Subsequent Surgerymentioning

confidence: 99%

Therapeutic Endoscopic Ultrasound for Complications of Pancreatic Cancer

Han,

Papachristou

2023

Cancers

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Progression of pancreatic adenocarcinoma can result in disease complications such as biliary obstruction and gastric outlet obstruction. The recent advances in endoscopic ultrasound (EUS) have transformed EUS from a purely diagnostic technology to a therapeutic modality, particularly with the development of lumen-apposing metal stents. In terms of biliary drainage, EUS-guided choledochoduodenostomy and EUS-guided hepaticogastrostomy offer safe and effective techniques when conventional transpapillary stent placement via ERCP fails or is not possible. If these modalities are not feasible, EUS-guided gallbladder drainage offers yet another salvage technique when the cystic duct is non-involved by the cancer. Lastly, EUS-guided gastroenterostomy allows for an effective bypass treatment for cases of gastric outlet obstruction that enables patients to resume eating within several days. Future randomized studies comparing these techniques to current standard-of-care options are warranted to firmly establish therapeutic EUS procedures within the treatment algorithm for this challenging disease.

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Pancreatoduodenectomy Following Preoperative Biliary Drainage Using Endoscopic Ultrasound-Guided Choledochoduodenostomy Versus a Transpapillary Stent: A Multicenter Comparative Cohort Study of the ACHBT–FRENCH–SFED Intergroup

Cited by 15 publications

References 32 publications

Endoscopic ultrasound-guided choledochoduodenostomy using single-step lumen-apposing metal stents for primary drainage of malignant distal biliary obstruction (SCORPION-p): a prospective pilot study

Endoscopic ultrasound-guided choledochoduodenostomy using single-step lumen-apposing metal stents for primary drainage of malignant distal biliary obstruction (SCORPION-p): a prospective pilot study

Utility of interventional endoscopic ultrasound in pancreatic cancer

Therapeutic Endoscopic Ultrasound for Complications of Pancreatic Cancer

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