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DOI: 10.1055/s-0039-1681841
BEYOND PALLIATION: USING EUS-GUIDED CHOLEDOCHODUODENOSTOMY WITH A LUMEN-APPOSING METAL STENT AS A BRIDGE TO SURGERY
Publication History
Publication Date:
18 March 2019 (online)
Introduction:
We analyzed the efficacy of pylorus-preserving pancreaticoduodenectomy (PPPD) after endoscopic ultrasonography-guided choledochoduodenostomy (EUS-CD) using a lumen-apposing metal stent (LAMS) as a bridge to surgery.
Patients and methods:
Retrospective multicentric analysis of all consecutive failed-ERCP patients (06/2017 – 10/2017) who subsequently underwent EUS-CD using LAMS, followed by PPPD with resectable distal malignant biliary obstruction.
Results:
Five patients underwent an EUS-CD using EC-LAMS; the bile duct was accessed using the transbulbar approach. The technical success rate of EUS-CD was 100%. No procedure-related adverse events occurred. Five patients underwent PPPD with a technical success rate of 100%.
The presence of a transduodenal LAMS did not impede surgery. No cases of biliary or duodenal fistula occurred. Pancreatic fistulas with late bleeding were observed in 2 patients (1 fatal).
Discussion and conclusion:
These few cases indicate that PPPD after EUS-CD using LAMS is feasible and safe.
EUS-CD should be performed irrespective of the stage of the disease, also for patients fit for surgery.
Additional larger prospective studies are required to confirm this preliminary data, in particular for possible interference with postoperative outcomes.