LONG-TERM PATENCY AND NEED-FOR-REINTERVENTIONS OF EUS-GUIDED CHOLEDOCODUODENOSTOMY WITH ELECTROCAUTERY-ENHANCED LUMEN APPOSING METAL STENTS: A SINGLE-CENTRE PROSPECTIVE EVALUATION.

Aims EUS-guided Choledocho-Duodenostomy (EUS-CD) with electrocautery-enhanced Lumen Apposing Metal Stents (ec-LAMS) is an established alternative for biliary drainage in patients with distal malignant biliary obstruction (dMBO) in whom conventional retrograde drainage fails. However, long-term prospective evaluations are lacking

Methods All consecutive EUS-CD with ec-LAMS performed in a tertiary academic centre between 2017-2021 were included. Patients with follow-up (FU) > 30 days were included for prospective analysis of recurrence rate and reinterventions. Dysfunction-Free Survival (DFS) probability was estimated by Kaplan-Meier statistics.

Results Forty-seven patients (male 57.4%; median age 71 [64-77], 89.4% pancreatic cancer) underwent EUS-CD with ec-LAMS (Hot-Axios, Boston Scientific, Marlborough, US). Mean procedural time was 5 (3-6.2) min. Technical and clinical success were 97.9% and 91.3% respectively. Adverse events were registered in 5 patients (10.6%), including technical/clinical failures. Among 30 prospectively followed patients with > 30 days (median 108 [62-255] days) of FU, 9 (30%) dysfunction cases (8 stones/food impactions and 1 stent migration) were registered. Median time-to-dysfunction was 255 [156-305] days. In almost all cases (8/9, 88.9%) endoscopic reinterventions (stone extraction, LAMS exchange, conversion to ERCP or EUS-hepaticogastrostomy) were successful. 6- and 12-months probability of stent dysfunction was 7.7% and 59% respectively at Kaplan-Meier curve, with an estimated median DFS of 364 (95%CI 255-412) days.

Conclusions As EUS-CD spreads, recurrence might be a frequent long-term issue, comparable to the rate reported for retrograde biliary SEMS. Clinicians should be aware that endoscopic revision is effective and safe in almost all cases. (PROTECT Registry, ClinicalTrials.gov NCT04813055).

Publication History

Article published online:
14 April 2022