Endoscopy 2021; 53(S 01): S237
DOI: 10.1055/s-0041-1724917
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EUS-Guided Gallbladder Drainage Using Lumen-Apposing Metal Stent As Rescue Treatment For Malignant Distal Biliary Obstruction: A Large Multicenter Experience

C Binda
1   AUSL Romagna, Gastroenterology and Digestive Endoscopy Unit, Forlì-Cesena Hospitals, Forlì-Cesena, Italy
,
A Anderloni
2   Humanitas Clinical and Research Center - IRCCS, Digestive Endoscopy Unit, Rozzano (MI), Italy
,
A Fugazza
2   Humanitas Clinical and Research Center - IRCCS, Digestive Endoscopy Unit, Rozzano (MI), Italy
,
A Amato
3   Valduce Hospital, Department of Gastroenterology, Como, Italy
,
G de Nucci
4   ASST Rhodense, Gastroenterology and Endoscopy Unit, Garbagnate Milanese (MI), Italy
,
A Redaelli
5   San Gerardo Hospital, Endoscopy Unit, Monza, Italy
,
R Di Mitri
6   ARNAS Civico Hospital, Gastroenterology and Endoscopy Unit, Palermo, Italy
,
L Cugia
7   Azienda Ospedaliero Universitaria Sassari, Division of Gastroenterology and Digestive Endoscopy, Department of Emergency, Sassari, Italy
,
V Pollino
8   S. Michele Hospital, Digestive Endoscopy Unit, Cagliari, Italy
,
R Macchiarelli
9   A.O.U.S. Policlinico S.Maria alle Scotte, Gastroenterology Unit, Siena, Italy
,
B Mangiavillano
10   Humanitas - Mater Domini, Gastrointestinal Endoscopy Unit, Castellanza, Italy
,
E Forti
11   Ospedale Ca’ Granda Niguarda, Digestive and Interventional Endoscopy Unit, Milano, Italy
,
ML Brancaccio
12   S. Maria delle Croci Hospital, Division of Gastroenterology, Ravenna, Italy
,
R Badas
13   University Hospital, Digestive Endoscopy Unit, Cagliari, Italy
,
M Maida
14   S. Elia-Raimondi Hospital, Gastroenterology and Endoscopy Unit, Caltanissetta, Italy
,
E Sinagra
15   Fondazione Istituto G. Giglio, Gastroenterology and Endoscopy Unit, Cefalù, Italy
,
A Repici
2   Humanitas Clinical and Research Center - IRCCS, Digestive Endoscopy Unit, Rozzano (MI), Italy
16   Humanitas University, Department of Biomedical Sciences, Pieve Emanuele, Milano, Italy
,
C Fabbri
1   AUSL Romagna, Gastroenterology and Digestive Endoscopy Unit, Forlì-Cesena Hospitals, Forlì-Cesena, Italy
,
I Tarantino
17   IRCCS-ISMETT, Endoscopy Service, Department of Diagnostic and Therapeutic Services, Palermo, Italy
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    Aims Evaluation of safety and effectiveness of endoscopic ultrasound-guided gallbladder (EUS-GBD) with lumen apposing metal stent (LAMS) as a rescue treatment for the relief of jaundice in patients with malignant distal biliary obstruction (MDBO) and failure both of endoscopic retrograde cholangiopancreatography (ERCP) and EUS-guided choledochoduodenostomy (EUS-CDS).

    Methods This is a multicenter, retrospective analysis including all consecutive cases of EUS-GBD with LAMS performed as rescue treatment in patients with MDBO in 14 Italian Centers from June 2015 to June 2020.

    Primary endpoints were technical and clinical success, defined as the proper LAMS positioning and a drop of bilirubin of at least 50 % after two weeks respectively. Secondary endpoint was the adverse events (AEs) rate.

    Results A total of 48 patients (52.1 % female) with a mean age of 74.3 ± 11.7 were included in the study. Biliary stricture was related to pancreatic adenocarcinoma (85.4 %), duodenal adenocarcinoma (2.1 %), cholangiocarcinoma (4.2 %), ampullary cancer (2.1 %), colon cancer (4.2 %) and metastatic breast cancer (2.1 %). LAMS were placed transgastric in 58.3 % of cases and transduodenal in 41.7 %. Technical success was 100 %, while clinical success was 81.3 %, with a mean total bilirubin reduction after two weeks of 66.5 %. Mean hospital stay was 9.2 ± 8.2 days. Adverse events occurred in 5/48 pts (10.4 %) (two mild and three moderate according to ASGE lexicon). AEs were classified as intraprocedural in three cases and delayed (more than 15 days) in two cases. The mean follow-up was 122±161 days.

    Conclusions The results of our study show that EUS-GBD with LAMS performed as rescue treatment in patients with MDBO has a high technical and clinical success rates, with an acceptable AEs rate and could be considered as a valuable alternative therapeutical approach in this setting of patients. To the best of our knowledge this is the largest study concerning this procedure.

    Citation Binda C, Anderloni A, Fugazza A et al. eP427 EUS-GUIDED GALLBLADDER DRAINAGE USING LUMEN-APPOSING METAL STENT AS RESCUE TREATMENT FOR MALIGNANT DISTAL BILIARY OBSTRUCTION: A LARGE MULTICENTER EXPERIENCE. Endoscopy 2021; 53: S237.


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    Publication History

    Article published online:
    19 March 2021

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