Eus Guided Choledochoduodenostomy With Electrocautery Enhanced Lumen Apposing Metal Stents in the Treatment of Malignant Distal Biliary Obstruction: Multi-Centre Collaboration From the Uk and Ireland

Aims Endoscopic ultrasound guided choledochoduodenostomy (EUS-CDD) with electrocautery enhanced lumen apposing metal stents (EC-LAMS) has recently emerged as a viable option in the management of patients with malignant distal biliary obstruction (MDBO). We conducted a multi-centre collaboration from the UK and Ireland with an aim to analyse the pooled efficacy, safety and long term outcomes of EUS-CDD for treatment of MDBO.

Methods Consecutive patients with MDBO who underwent EUS-CDD with EC-LAMS at 8 tertiary hepatopancreatobiliary institutions between September 2016 and September 2020 were retrospectively analysed. Recorded variables included patient demographics, procedural characteristics and follow-up data.

Results 112 patients (59 male) were identified. The mean age was 72 years old (range 46 - 94 years old). Pancreatic adenocarcinoma was the commonest underlying malignancy in 63.4 % (n = 71). The indications for EUS-CDD were: an inaccessible papilla (n = 49), tumour infiltration of papilla (n = 29) and unsuccessful biliary cannulation/stricture impassable with guidewire (n = 34). Technical success was achieved in 91.1 % (n = 102) of patients. Additional stenting with plastic pigtails through the EC-LAMS was performed in 26 patients at the discretion of the endoscopist to augment biliary drainage. Data for clinical success (reduction of serum bilirubin to ≤50 % of original value at day 7) was available for 90 patients and was achieved in 94.4 % of these (n = 84). The adverse event rate was 16.9 % (n = 19) and further details are summarised in the table. The biliary re-intervention rate was 8.1 % (n=8) in 99 patients with successful EUS-CDD and sufficient data (3 lost to follow-up), over a median follow-up of 70 days (range 3 - 761 days). Eight patients underwent attempted surgical resection of their primary tumour and in those who did, resection and formation of hepaticojejunostomy was successful.

Tab. 1

Severity of adverse event	Adverse event description
Mild (n = 6)	Cholangitis with no stent occlusion treated with antibiotics (n = 5)
	Pneumoperitoneum post stent deployment; bridged with metal stent with no post-procedural clinical consequence (n = 1)
Moderate (n = 11)	Cholangitis and stent occlusion requiring re-intervention (n = 6)
	Stent migration requiring re-intervention (n = 2)
	Stent occlusion without cholangitis requiring re-intervention (n = 1)
	Bile leak due to malposition of stent requiring re-intervention (n = 1)
	Bile leak due to maldeployment of stent; managed conservatively (n = 1)
Severe (n = 2)	Duodenal perforation requiring laparotomy (n = 2)

Conclusions We present the first collaborative data from the UK and Ireland demonstrating EUS-CDD in MDBO to be efficacious with a reasonable safety profile.

Citation: On W, Paranandi B, Smith AM et al. OP96 EUS GUIDED CHOLEDOCHODUODENOSTOMY WITH ELECTROCAUTERY ENHANCED LUMEN APPOSING METAL STENTS IN THE TREATMENT OF MALIGNANT DISTAL BILIARY OBSTRUCTION: MULTI-CENTRE COLLABORATION FROM THE UK AND IRELAND. Endoscopy 2021; 53: S41.

Publication History

Article published online:
19 March 2021