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CC BY-NC-ND 4.0 · Endosc Int Open 2021; 09(11): E1801-E1810
DOI: 10.1055/a-1526-1208
Original article

Common bile duct size in malignant distal obstruction and lumen-apposing metal stents: a multicenter prospective study

Mihai Rimbaş
 1   Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
 3   Department of Internal Medicine, Carol Davila University of Medicine, Bucharest, Romania
,
Andrea Anderloni
 4   Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Clinical and Research Center, IRCCS, Rozzano, Milan, Italy
,
Bertrand Napoléon
 5   Endoscopy Unit, Jean Mermoz Private Hospital, Ramsay Generale de Santé, Lyon, France
,
Andrada Seicean
 6   Department of Gastroenterology, Regional Institute of Gastroenterology and Hepatology, Iuliu Haţieganu University of Medicine, Cluj-Napoca, Romania
,
Edoardo Forti
 7   Digestive Endoscopy Unit, Grande Ospedale Metropolitano Niguarda, Milan, Italy
,
Stefano Francesco Crinò
 8   Gastroenterology and Digestive Endoscopy Unit, The Pancreas Institute, G.B. Rossi University Hospital, Verona, Italy
,
Ilaria Tarantino
 9   Endoscopy Service, Department of Diagnostic and Therapeutic Services, Istituto Mediterraneo per i Trapianti e Terapie ad alta Specializzazione, Palermo, Italy
,
Paolo Giorgio Arcidiacono
10   Pancreato-Biliary Endoscopy and Endosonography Division, Pancreas Translational & Clinical Research Center, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy
,
Carlo Fabbri
11   Gastroenterology and Digestive Endoscopy Unit, Forlì-Cesena Hospitals, AUSL Romagna, Italy
,
Gianenrico Rizzatti
 1   Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
12   CERTT, Center for Endoscopic Research Therapeutics and Training, Catholic University, Rome, Italy
,
Arnaldo Amato
13   Gastroenterology Division, Valduce Hospital, Como, Italy
,
Theodor Voiosu
 2   Gastroenterology Department, Colentina Clinical Hospital, Bucharest, Romania
 3   Department of Internal Medicine, Carol Davila University of Medicine, Bucharest, Romania
,
Alessandro Fugazza
 4   Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Clinical and Research Center, IRCCS, Rozzano, Milan, Italy
,
Ofelia Moșteanu
 6   Department of Gastroenterology, Regional Institute of Gastroenterology and Hepatology, Iuliu Haţieganu University of Medicine, Cluj-Napoca, Romania
,
Àngels Ginès
14   Endoscopy Unit, Institut de Malalties Digestives i Metabòliques, Hospital Clínic, University of Barcelona, IDIBAPS, CIBEREHD, Barcelona, Spain
,
Germana de Nucci
15   Gastroenterology Unit, ASST Rhodense, Garbagnate Milanese, Italy
,
Pietro Fusaroli
16   Gastroenterology Unit, Hospital of Imola, Department of Medical and Surgical Sciences, University of Bologna, Italy
,
Nam Quoc Nguyen
17   Department of Gastroenterology, Royal Adelaide Hospital, Adelaide, Australia
,
Roberto Di Mitri
18   Gastroenterology and Endoscopy Unit, ARNAS Civico – Di Cristina – Benfratelli, Palermo, Italy
,
Leonardo Minelli Grazioli
19   Digestive Endoscopy Unit and Gastroenterology, Fondazione Poliambulanza, Brescia, Italia
,
Massimiliano Mutignani
 7   Digestive Endoscopy Unit, Grande Ospedale Metropolitano Niguarda, Milan, Italy
,
Livia Archibugi
10   Pancreato-Biliary Endoscopy and Endosonography Division, Pancreas Translational & Clinical Research Center, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy
,
Cecilia Binda
11   Gastroenterology and Digestive Endoscopy Unit, Forlì-Cesena Hospitals, AUSL Romagna, Italy
,
Anna Cominardi
16   Gastroenterology Unit, Hospital of Imola, Department of Medical and Surgical Sciences, University of Bologna, Italy
,
Carmelo Barbera
20   U.O.C. di Gastroenterologia ed Endoscopia Digestiva, Ospedale Giuseppe Mazzini, ASL Teramo, Italy
,
Glòria Fernández-Esparrach
14   Endoscopy Unit, Institut de Malalties Digestives i Metabòliques, Hospital Clínic, University of Barcelona, IDIBAPS, CIBEREHD, Barcelona, Spain
,
Laurent Palazzo
21   Department of Endoscopy, Trocadero Clinic, Paris, France
,
Maxime Palazzo
22   Digestive Endoscopy Unit, Beaujon University Hospital, Clichy-la-Garenne, France
,
Jan Werner Poley
23   Department of Gastroenterology and Hepatology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
,
Cristiano Spada
 1   Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
19   Digestive Endoscopy Unit and Gastroenterology, Fondazione Poliambulanza, Brescia, Italia
,
Giorgio Valerii
20   U.O.C. di Gastroenterologia ed Endoscopia Digestiva, Ospedale Giuseppe Mazzini, ASL Teramo, Italy
,
Takao Itoi
24   Department of Gastroenterology and Hepatology, Tokyo Medical University Hospital, Tokyo, Japan
,
Yukitoshi Matsunami
24   Department of Gastroenterology and Hepatology, Tokyo Medical University Hospital, Tokyo, Japan
,
Radu Bogdan Mateescu
 2   Gastroenterology Department, Colentina Clinical Hospital, Bucharest, Romania
 3   Department of Internal Medicine, Carol Davila University of Medicine, Bucharest, Romania
,
Cristian Băicuș
 3   Department of Internal Medicine, Carol Davila University of Medicine, Bucharest, Romania
,
Guido Costamagna
 1   Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
12   CERTT, Center for Endoscopic Research Therapeutics and Training, Catholic University, Rome, Italy
,
Alberto Larghi
 1   Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
12   CERTT, Center for Endoscopic Research Therapeutics and Training, Catholic University, Rome, Italy
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Abstract

Background and study aims Feasibility of EUS-guided choledochoduodenostomy (EUS-CDS) using available lumen-apposing stents (LAMS) is limited by the size of the common bile duct (CBD) (≤ 12 mm, cut-off for experts; 15 mm, cut-off for non-experts). We aimed to assess the prevalence and predictive factors associated with CBD size ≥ 12 and 15 mm in naïve patients with malignant distal biliary obstruction (MDBO).

Patients and methods This was a prospective cohort study involving 22 centers with assessment of CBD diameter and subjective feasibility of the EUS-CDS performance in naïve jaundiced patients undergoing EUS evaluation for MDBO.

Results A total of 491 patients (mean age 69 ± 12 years) with mean serum bilirubin of 12.7 ± 6.6 mg/dL entered the final analysis. Dilation of the CBD ≥ 12 and 15 mm was detected in 78.8 % and 51.9 % of cases, respectively. Subjective feasibility of EUS-CDS was expressed by endosonographers in 91.2 % for a CBD ≥ 12 mm and in 96.5 % for a CBD ≥ 15 mm. On multivariate analysis, age (P < 0.01) and bilirubin level (P ≤ 0.001) were the only factors associated with both CBD dilation ≥ 12 and ≥ 15 mm. These variables were poorly associated with the extent of duct dilation; however, based on them a prediction model could be constructed that satisfactorily predicted CBD size ≥ 12 mm in patients at least 70 years and a bilirubin level ≥ 7 mg/dL.

Conclusions Our study showed that at presentation in a large cohort of patients with MDBO, EUS-CDS can be potentially performed in three quarters to half of cases by expert and less experienced endosonographers, respectively. Dedicated stents or devices with different designs able to overcome the limitations of existing electrocautery-enhanced LAMS for EUS-CDS are needed.



Publication History

Received: 04 April 2021

Accepted: 26 May 2021

Article published online:
12 November 2021

© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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