LUMEN-APPOSING METAL STENTS (LAMS) VERSUS FULLY COVERED SELF-EXPANDABLE METAL STENT (SEMS) IN ENDOSCOPIC ULTRASOUND-GUIDED CHOLEDOCHODUODENOSTOMY (EUS-CDS) FOR DISTAL MALIGNANT BILIARY OBSTRUCTION (DMBO)

Aims EUS-CDS is an alternative to PTBD in unresectable distal MBO after failed ERCP. Electrocautery enhanced delivery system (EC-LAMS) facilitates access to the target lumen simplifying the classic multi-step procedure of EUS-CDS. It is unknown if LAMS improve results obtained with SEMS. We sought to compare LAMS vs SEMS for EUS-CDS after failed ERCP in DMBO.

Tab. 1

	LAMS (n=37)	SEMS (n=20)	p
Edad, median(IQR)	81,8(69,9-84,6)	80,2(67,6-86,3)	0,97
Underlying disease, n(%) -Pancreatic adenocarcinoma -Other	29(78,4) 8(21,6)	17(85%) 3(15%)	0,40
ASA Group, n(%) -I/II -III/IV Not available	9(24,3%) 25(67,7%) 3(8,1%)	11(55%) 6(30%) 3(15%)	0,04

Methods This unicentric retrospective cohort-study was conducted on patients who underwent LAMS or SEMS placement by EUS-CDS for DMBO after failed ERCP between January-2011/January-2019. The primary endpoint was the clinical success after stent placement (reduction in serum bilirubin levels by at least 50% over baseline). Secondary endpoints included median time until event (death or reintervention), adverse events, recurrence and secondary interventions.

Results 57 patients were included in our study 37 LAMS and 20 SEMS were placed ([Table]). Short-term clinical success was achieved in 94,6 % (LAMS group) compared to 100% (SEMS group), with no difference between groups (p< 0,67). The median time until event was 92.5 days in LAMS group and 77 days in SEMS group, also without differences. There were also no differences in the rates of adverse events, recurrence and secondary interventions.

Conclusions EUS-CDS represents an effective therapeutic option for patients with distal MBO, without differences between the use of LAMS and SEMS in terms of clinical success, adverse events, recurrence and secondary interventions. Even if the use of EC-LAMS simplifies the classic multi-step procedure, however, increased costs over the classical SEMS do not appear to translate into improved outcomes. Therefore, further studies are needed to establish the cost-effectiveness of LAMS for EUS-CDS.