Transenteric anastomosis with lumen-apposing metal stent as a conduit for iterative endotherapy of malignant biliary obstruction in altered anatomy

Pérez-Miranda, Manuel; Sánchez-Ocaña, Ramón; Higuera, Carlos de la Serna; Díez-Redondo, Pilar; Núñez, Henar; Vallecillo, M. A.

doi:10.1016/j.gie.2014.04.030

Cited by 13 publications

(17 citation statements)

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“…A preliminary search yielded 14 original studies which included 2 prospectively designed studies [ 11 , 12 ], 3 retrospective studies [ 13 - 15 ], 3 case series [ 16 - 18 ], and 6 case reports [ 19 - 24 ]. On further reading of selected articles, 2 articles were excluded due to duplication of represented population [ 12 , 15 ] and one article was excluded due to lack of data regarding the type of stent used [ 18 ].…”

Section: Resultsmentioning

confidence: 99%

“…The second most common indication was ALS, in 11.4% (9/79) cases [ 16 , 17 , 20 , 21 ]. The two less common indications were to gain endoscopic access to relieve biliary obstruction (1.3%) [ 19 ] and efferent limb obstruction (2.5%) [ 22 , 23 ]. In 74.7% cases, the underlying etiology was malignant [ 11 , 13 , 14 , 16 , 17 , 19 - 21 , 24 ], whereas in the rest it was benign (25.3%) [ 11 , 13 , 17 , 22 , 23 ].…”

Section: Discussionmentioning

confidence: 99%

“…No data was reported regarding prior interventions in 38% (30/79) of the cohort [ 14 ]. Endoscopic ultrasound (EUS)-guided de-novo anastomosis was the preferred as first line treatment in 26.6% (21/79) cases [ 11 , 13 , 16 , 21 - 24 ], and as secondary treatment (after failed primary interventions) in 35.4% (28/79) patients [ 11 , 13 , 17 , 19 , 20 ]. Prior interventions included endoscopic dilation [ 11 ], SEMS [ 11 , 13 ], percutaneous endoscopic gastrostomy or jejunostomy [ 11 ], nasal-jejunal tube [ 11 ], enteroscopy [ 17 , 19 ], endoscopy [ 20 ], EUS-guided biliary drainage [ 19 ], percutaneous transhepatic biliary drainage [ 17 , 19 ].…”

Section: Discussionmentioning

confidence: 99%

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<i>De-novo</i> Gastrointestinal Anastomosis with Lumen Apposing Metal Stent

Jain¹,

Chhoda²,

Sharma³

et al. 2018

Clin Endosc

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Gastric outlet obstruction, afferent or efferent limb obstruction, and biliary obstruction among patients with altered anatomy often require surgical intervention which is associated with significant morbidity and mortality. Endoscopic dilation for benign etiologies requires multiple sessions, whereas self-expandable metal stents used for malignant etiologies often fail due to tumor in-growth. Lumen apposing metal stents, placed endoscopically with the intent of creating a de-novo gastrointestinal anastomosis bypassing the site of obstruction, can potentially achieve similar efficacy, with a much lower complication rate. In our study cohort (n=79), the composite technical success rate and clinical success rate was 91.1% (72/79) and 97.2% (70/72), respectively. Five different techniques were used: 43% (34/79) underwent the balloon-assisted method, 27.9% (22/79) underwent endoscopic ultrasound-guided balloon occluded gastro-jejunostomy bypass, 20.3% (16/79) underwent the direct technique, 6.3% (5/79) underwent the hybrid rendezvous technique, and 2.5% (2/79) underwent natural orifice transluminal endoscopic surgery (NOTES)-assisted procedure. All techniques required an echoendoscope except NOTES. In all, 53.2% (42/79) had non-cautery enhanced Axios stent, 44.3% (35/79) had hot Axios stent, and 2.5% (2/79) had Niti-S spaxus stent. Symptom-recurrence was seen in 2.8%, and 6.3% had a complication (bleeding, abdominal pain or peritonitis). All procedures were performed by experts at centers of excellence with adequate surgical back up.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

<i>De-novo</i> Gastrointestinal Anastomosis with Lumen Apposing Metal Stent

Jain¹,

Chhoda²,

Sharma³

et al. 2018

Clin Endosc

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“…Transjejunal ERCP through EUS-guided entero-anastomoses [27] ERCPs on an intention-to-treat, except when a) prior EUS-DAD readily offered transmural access fistulas [24,25] (Fig.1b); or b) biliary metal stents blocked-off…”

Section: Accepted M Manuscriptmentioning

confidence: 99%

The role of endoscopic ultrasound guidance for biliary and pancreatic duct access and drainage to overcome the limitations of ERCP: a retrospective evaluation

et al. 2020

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Background EUS-guided ductal access and drainage (EUS-DAD) of biliary/pancreatic ducts after failed ERCP is less invasive than percutaneous transhepatic biliary drainage (PTBD). The actual need for EUS-DAD remains unknown. We aimed to determine how often EUS-DAD is needed to overcome ERCP failure. Methods Consecutive duct access procedures (n=2205; 95% biliary) performed between June 2013-November 2015 at a tertiary-care center were reviewed. ERCP was used first-line, EUS-DAD as salvage of ERCP, and PTBD when both failed. Procedures were defined as index in patients without prior endoscopic duct access and combined when EUS-DAD followed successful ERCP. The main outcomes were EUS-DAD and PTBD rates. Results EUS-DAD was performed overall in 7.7% (170/2205), 9.1% (116/1274) index and 5.8% (54/931) follow-up procedures. Most index EUS-DADs were performed following (46%) or anticipating (39%) ERCP failure, whereas 15% followed successful ERCP (combined procedures). Among index procedures, the EUS-DAD rate was higher in surgically-altered anatomy (58.2% [39/67)] vs. 6.4% [77/1207]). PTBD was required in 0.2% (3/1274). Among follow-up procedures, ERCP represented 85.7%, cholangio-pancreatography through mature transmural fistulas 8.5% and EUS-DAD 5.8%. No patient required PTBD. The secondary PTBD rate was 0.1% (3/2205). Six primary PTBDs were performed (0.4% [9/2211] overall PTBD rate). Conclusions EUS-DAD was required in 7.7% of ERCPs for benign and malignant biliary/pancreatic duct indications. Salvage PTBD was required in 0.1%. This high EUS-DAD rate reflects disease complexity, a wide definition of ERCP failure and restrictive PTBD use, not poor ERCP skills. EUS-DAD effectively overcomes ERCP limitations precluding primary and salvage PTBD in most cases.

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“…25 Its application in distal Roux limbs requires access through an overtube or adult colonoscope or a loop of proximal bowel contiguous to the site of obstruction and accessible by an endoscopic ultrasonography scope. 26 There have been no compar-ative studies using these various methods of luminal decompression in patients with Roux-en-Y obstruction, to date, although endoscopic treatments in high risk patients minimize the risks of bleeding or bile leak compared with percutaneous transhepatic biliary drainage and the postoperative complications of revisional surgery.…”

Section: Roux-en-y Obstructionmentioning

confidence: 99%

Endoscopic approaches to afferent and Roux-en-Y limb obstruction

Kozarek

2016

Int J Gastrointest Interv

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Afferent limb syndrome can be seen following Billroth II gastric resection, Whipple procedure with duodenojejunostomy, or in association with an obstructed Roux-en-Y limb following hepaticojejunostomy. This syndrome classically presents with jaundice or cholangitis but may also be associated with abdominal pain alone or pancreatitis, especially in patients with surgically created pancreaticojejunostomies. Obstructions may be a consequence of benign or malignant disorders. Historically treated with surgery or percutaneous transhepatic biliary drainage, this review describes currently applied and evolving endoscopic techniques to include balloon dilation, double pigtail plastic stent placement, and insertion of self-expandable metal stents or lumen-apposing stents.

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Transenteric anastomosis with lumen-apposing metal stent as a conduit for iterative endotherapy of malignant biliary obstruction in altered anatomy

Cited by 13 publications

References 0 publications

<i>De-novo</i> Gastrointestinal Anastomosis with Lumen Apposing Metal Stent

<i>De-novo</i> Gastrointestinal Anastomosis with Lumen Apposing Metal Stent

The role of endoscopic ultrasound guidance for biliary and pancreatic duct access and drainage to overcome the limitations of ERCP: a retrospective evaluation

Endoscopic approaches to afferent and Roux-en-Y limb obstruction

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