ENDOSCOPIC ULTRASOUND-GUIDED BILIARY DRAINAGE USING ELECTROCAUTERY-ENHANCED LUMEN APPOSING METAL STENTS IS A SAFE AND EFFECTIVE PROCEDURE FOR DISTAL MALIGNANT BILIARY OBSTRUCTIONS

Aims Endoscopic ultrasound-guided biliary drainage (EUS-BD) for distal malignant biliary obstruction (MBO) is the treatment of choice after unsuccessful of endoscopic retrograde colangiopancreatography (ERCP). However the use of conventional, not dedicated stents carries a high risk of biliary leakage and adverse events. Lumen apposing metal stent with a cautery-enhanced delivery system (EC-LAMS) is a novel and promising tool that allows a BD in a single step procedure. In this study we evaluated the efficacy and safety of this stent in patients with MBO.

Methods We conduct a retrospective analysis of consecutive patients affected by MBO who, between April 2017 and September 2019, underwent a EUS-BD with EC-LAMS after ERCP failure. Primary outcome was to evaluate the technical and clinical effectiveness of the procedure. Secondary outcomes were occurrence of adverse events, procedure time, and stent patency.

Results Fourteen patients with MBO underwent BD using the study device. Technical success was obtained in 93% of patients (13/14), with a transduodenal bile duct access in 93% (13/14). Clinical success, defined as decline of serum bilirubin levels of 50% within 2 weeks, was obtained in 92% of the patients (12/13). Mean time of procedure was 17.8 minutes (DS 6.69). No procedure-related mortality was noted. In 2 patients with resectable pancreatic adenocarcinoma the Whipple procedure was performed after EUS coledocoduodenostomy for preoperative drainage and the duodenal LAMS did not interfere with surgery. Post procedural adverse events included fever (N = 2) and abdominal pain (N = 1), both treated conservatively. During the follow up 1 patient showed food impaction of the stent successfully treated by endoscopic debridement removal.

Conclusions EUS-BD with EC-LAMS is an effective and easy to perform treatment in MBO, with low rate of adverse events. Additional prospective studies are needed to validate this data, assess long term efficacy of the LAMS and its feasibility in patients candidate for pancreatic surgery.