Single-stage EUS-guided choledochoduodenostomy using a lumen-apposing metal stent for malignant distal biliary obstruction

Anderloni, Andrea; Fugazza, Alessandro; Troncone, Edoardo; Auriemma, Francesco; Carrara, Sandro; Semeraro, R.; Maselli, Roberta; Leo, Milena Di; D’Amico, Ferdinando; Sethi, Amrita; Repici, Alessandro

doi:10.1016/j.gie.2018.08.047

Cited by 140 publications

(115 citation statements)

References 25 publications

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“…A major limitation of the procedure is that it is technically feasible only in patients with extrahepatic biliary ductal dilation (choledochoduodenostomy) in whom the stent can be deployed free‐hand or over a previously placed guidewire. Three studies have examined the role of LAMS in biliary obstruction and reported a technical success rate that was approximately 90% or higher and a clinical success greater than 90%; however, the rates of adverse events were 3.8%, 11.5% and 36.8%, respectively . Although one patient experienced fatal bleeding, other adverse events included food impaction, spontaneous migration and kinking.…”

Section: Current Clinical Applicationsmentioning

confidence: 99%

“…Three studies have examined the role of LAMS in biliary obstruction and reported a technical success rate that was approximately 90% or higher and a clinical success greater than 90%; however, the rates of adverse events were 3.8%, 11.5% and 36.8%, respectively. [12][13][14] Although one patient experienced fatal bleeding, other adverse events included food impaction, spontaneous migration and kinking. It appears that the existing design of LAMS is not conducive to biliary ductal drainage and may require modification to minimize the incidence of adverse events.…”

Section: Biliary Obstructionmentioning

confidence: 99%

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Lumen‐apposing metal stents for endoscopic ultrasonography‐guided interventions

Bang

Varadarajulu

2019

Digestive Endoscopy

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Lumen‐apposing metal stents (LAMS) are integrated in a single‐step delivery platform and can be deployed under endoscopic ultrasound‐guidance for the drainage of intra‐abdominal fluid collections, decompression of obstructed ductal systems, establishment of anastomosis or creation of fistulous tracts between organs that can facilitate further endoscopic interventions if required. A unique feature of LAMS is their ability to approximate the adjoining structures, thereby minimizing the potential for leak and perforation. Consequently, the innovation has advanced our ability to carry out complex therapeutic interventions and obviate the need for high‐risk surgical procedures, particularly in morbid patients. However, a keen awareness of the technical design of LAMS and its implication on treatment effect is important to minimize adverse events and to improve clinical outcomes. This review outlines the technical approach to placement of LAMS, procedural challenges, adverse events, current clinical indications and emerging applications.

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Section: Current Clinical Applicationsmentioning

confidence: 99%

Section: Biliary Obstructionmentioning

confidence: 99%

Lumen‐apposing metal stents for endoscopic ultrasonography‐guided interventions

Bang

Varadarajulu

2019

Digestive Endoscopy

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“…28 More recently, the use of lumen-apposing metal stents for EUS-CDS has been successfully demonstrated, expanding the toolbox of modalities. 34 Additional experience will streamline and potentially standardize the management of GOBO scenarios.…”

Section: Discussionmentioning

confidence: 99%

Review of Simultaneous Double Stenting Using Endoscopic Ultrasound-Guided Biliary Drainage Techniques in Combined Gastric Outlet and Biliary Obstructions

et al. 2020

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Concomitant malignant gastric outlet obstruction and biliary obstruction may occur in patients with advanced cancers affecting these anatomical regions. This scenario presents a unique challenge to the endoscopist in selecting an optimal management approach. We sought to determine the efficacy and safety of endoscopic techniques for treating simultaneous gastric outlet and biliary obstruction (GOBO) with endoscopic ultrasound (EUS) guidance for biliary drainage. An extensive literature search for peer-reviewed published cases yielded 6 unique case series that either focused on or included the use of EUS-guided biliary drainage (EUS-BD) with simultaneous gastroduodenal stenting. In our composite analysis, a total of 51 patients underwent simultaneous biliary drainage through EUS, with an overall reported technical success rate of 100% for both duodenal stenting and biliary drainage. EUS-guided choledochoduodenostomy or EUS-guided hepaticogastrostomy was employed as the initial technique. In 34 cases in which clinical success was ascribed, 100% derived clinical benefit. The common adverse effects of double stenting included cholangitis, stent migration, bleeding, food impaction, and pancreatitis. We conclude that simultaneous double stenting with EUS-BD and gastroduodenal stenting for GOBO is associated with high success rates. It is a feasible and practical alternative to percutaneous biliary drainage or surgery for palliation in patients with associated advanced malignancies. Clin Endosc 2020;53:167-175

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“…The hot AXIOS stent (Xlumena, Inc., Mountain View, CA, USA) is a fully covered, 10-mm-diameter delivery system, with 10-mm-long braided stent with bilateral 20-mm-diameter anchor flanges. These novel SEMSs are mainly used for EUS-guided pseudocystic drainage and EUS-guided cholecystogastrostomy [8][9][10]. These SEMSs also seem useful for EUS-CDS, although clinical trials are needed to confirm their utility.…”

Section: Technical Tipsmentioning

confidence: 99%

EUS-Guided Biliary Drainage

Ogura¹,

Higuchi²

2020

Advanced Endoscopy

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Endoscopic ultrasound-guided biliary drainage (EUS-BD) has been developed as an alternative method for failed endoscopic retrograde cholangiopancreatography (ERCP). EUS-BD can be divided into two main approach routes, such as transgastric or transduodenal approach. Also, EUS-guided hepaticogastrostomy, choledochoduodenostomy (CDS), and gallbladder drainage (GBD) have been reported. In this chapter, we described technical tips for each basic technique, including literature review. As advanced technique of EUS-BD, antegrade stone removal has been reported. More recently, electrohydraulic lithotripsy for bile duct stones under transluminal cholangioscopy guidance, hepaticojejunostomy stricture dilation through EUS-hepaticogastrostomy (HGS) route, or EUS-guided gastrojejunostomy has been reported. Although EUS-BD has various potential as treatment technique, treatment method should be selected for each patient's conditions.

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Single-stage EUS-guided choledochoduodenostomy using a lumen-apposing metal stent for malignant distal biliary obstruction

Cited by 140 publications

References 25 publications

Lumen‐apposing metal stents for endoscopic ultrasonography‐guided interventions

Lumen‐apposing metal stents for endoscopic ultrasonography‐guided interventions

Review of Simultaneous Double Stenting Using Endoscopic Ultrasound-Guided Biliary Drainage Techniques in Combined Gastric Outlet and Biliary Obstructions

EUS-Guided Biliary Drainage

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