ENDOSCOPIC ULTRASOUND-GUIDED DRAINAGE USING LAMS OF MALIGNANT AFFERENT LIMB SYNDROME IN PATIENTS WITH PREVIOUS WHIPPLE SURGERY: A MULTICENTER STUDY

Aims Endoscopic ultrasound-guided digestive anastomosis (EUS-A) is a new alternative under evaluation in patients presenting with afferent limb syndrome (ALS) after Whipple surgery. The aim of the present study is to analyze the safety and effectiveness of EUS-A in ALS.

Methods This is an observational multicenter study with 20 participating centers. All patients≥18 years-old with previous Whipple surgery presenting with ALS who underwent an EUS-A using a lumen apposing metal stent between 2015 and 2021 were included. The primary outcome was clinical success, defined as resolution of the ALS or ALS-related cholangitis. Furthermore, technical success, adverse event rate and mortality were evaluated.

Results Forty-five patients (mean age: 65.5±10.2 years, 44.4% male) were included. The most common underlying disease was pancreatic cancer (68.9%). EUS-A was performed at a median of 6 weeks after local tumor recurrence. The most common approach used was the direct/freehand technique (66.7%). Technical and clinical success were achieved in 95.6%%, with no differences between large (≥15mm) and small LAMS (97.4% vs. 100%, p=0.664). Clinical success was retained in and 91.1% of patients. A complementary treatment by dilation of the stent followed by ERCP through the LAMS was performed in three cases (6.7%). There were six recurrent episodes of cholangitis (14.6%) and two procedure-related adverse events (4.4%) after a median follow-up of 4 months. Twenty-six patients (57.8%) died during the follow-up due to disease progression.

Fig. 1

Conclusions EUS-A is a safe and effective technique in the treatment of malignant ALS, achieving high clinical success with an acceptable recurrence rate.

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Artikel online veröffentlicht:
14. April 2022