EUS-guided choledochoduodenostomy with electrocautery-enhanced lumen-apposing metal stents in patients with malignant distal biliary obstruction: multicenter collaboration from the United Kingdom and Ireland,Gastrointestinal Endoscopy

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EUS-guided choledochoduodenostomy with electrocautery-enhanced lumen-apposing metal stents in patients with malignant distal biliary obstruction: multicenter collaboration from the United Kingdom and Ireland
Gastrointestinal Endoscopy ( IF 7.7 ) Pub Date : 2021-10-09 , DOI: 10.1016/j.gie.2021.09.040
Wei On ₁ , Bharat Paranandi ₁ , Andrew M Smith ₁ , Suresh V Venkatachalapathy ₂ , Martin W James ₂ , Guruprasad P Aithal ₃ , Ioannis Varbobitis ₂ , Danny Cheriyan ₄ , Ciaran McDonald ₄ , John S Leeds ₅ , Manu K Nayar ₆ , Kofi W Oppong ₆ , Joe Geraghty ₇ , John Devlin ₈ , Wafaa Ahmed ₈ , Ryan Scott ₉ , Terence Wong ₁₀ , Matthew T Huggett ₁

Affiliation

Department of Gastroenterology, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
Department of Gastroenterology, NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust, University of Nottingham, Nottingham, UK.
Department of Gastroenterology, NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust, University of Nottingham, Nottingham, UK; Nottingham Digestive Diseases Centre, School of Medicine, University of Nottingham, Nottingham, UK.
Beaumont Hospital and RCSI, Dublin, Ireland.
Department of Gastroenterology, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK; Population Health Sciences Institute, Newcastle University, Newcastle, UK.
Department of Gastroenterology, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK.
Department of Gastroenterology, Manchester University NHS Foundation Trust, Manchester, UK.
Department of Gastroenterology, King's College Hospital NHS Foundation Trust, London, London, UK.
Department of Gastroenterology, Belfast Health and Social Care Trust, Belfast, Ireland.
Department of Gastroenterology, Guys' and St Thomas' NHS Foundation Trust, London, UK.

Background and Aims

EUS-guided choledochoduodenostomy (EUS-CDD) with an electrocautery-enhanced lumen-apposing metal stent (EC-LAMS) has emerged as a viable method of establishing biliary drainage in patients with malignant distal biliary obstruction (MDBO). Our aim was to assess the efficacy, safety, and outcomes in patients with MDBO who underwent EUS-CDD with an EC-LAMS.

Methods

A retrospective review of consecutive patients with MDBO who underwent EUS-CDD with EC-LAMSs at 8 tertiary institutions across the United Kingdom and Ireland between September 2016 and November 2020 was undertaken.

Results

One hundred twenty patients (55% men) with a median age of 73 years (interquartile range, 17; range, 43-94) were included. The median follow-up period in 117 patients was 70 days (interquartile range, 169; range, 3-869), and 23 patients (19.2%) were alive at the end of the follow-up. Three patients were lost to follow-up. Technical success was achieved in 109 patients (90.8%). Clinical success (reduction of serum bilirubin to ≤50% of original value within 14 days) was achieved in 94.8% of patients (92/97). The adverse event rate was 17.5% (n = 21). Biliary reintervention after initial technical success was required in 9 patients (8.3%).

Conclusions

EUS-CDD with EC-LAMSs at tertiary institutions within a regional hepatopancreatobiliary network for treatment of MDBO was effective in those where ERCP was not possible or was unsuccessful. When technical failures or adverse events occur, most patients can be managed with conservative or endoscopic therapy.

中文翻译：

EUS 引导下胆总管十二指肠吻合术与电灼增强管腔金属支架治疗恶性远端胆道梗阻患者：来自英国和爱尔兰的多中心合作

背景和目标

EUS 引导下的胆总管十二指肠吻合术 (EUS-CDD) 与电灼增强管腔金属支架 (EC-LAMS) 已成为在恶性远端胆道梗阻 (MDBO) 患者中建立胆道引流的可行方法。我们的目的是评估接受 EC-LAMS 的 EUS-CDD 的 MDBO 患者的疗效、安全性和结果。

方法

对 2016 年 9 月至 2020 年 11 月期间在英国和爱尔兰的 8 家三级机构接受 EUS-CDD 和 EC-LAMS 的连续 MDBO 患者进行了回顾性研究。

结果

包括 120 名患者（55% 男性），中位年龄为 73 岁（四分位距，17；范围，43-94）。117 名患者的中位随访期为 70 天（四分位距，169；范围，3-869），23 名患者（19.2%）在随访结束时存活。三名患者失访。109 名患者（90.8%）取得了技术上的成功。94.8% 的患者 (92/97) 取得了临床成功（血清胆红素在 14 天内降至原始值的 ≤50%）。不良事件发生率为 17.5%（n = 21）。9 名患者 (8.3%) 需要在初步技术成功后进行胆道再干预。