LONG TERM EFFICIENCY OF EUS GUIDED BILIARY DRAINAGE USING ELECTROCAUTERY ENHANCED LAMS IN CASE OF FAILED ERCP, A LARGE PROSPECTIVE STUDY OF 118 CASES

Aims EC-LAMS allows EUS guided choledocoduodenostomy in a single step, without prior bile duct puncture or the need for a guidewire when ERCP fails or is unfeasible.

Long term data about this new promising procedure are lacking.

Methods Prospective, observational, single-center study including all EUS guided biliary drainage for distal malignant obstruction with 6 mm EC-LAMS since first case in 2017.

The primary objective was to evaluate the long-term rate of stent dysfunction.

The secondary objectives were to evaluate the short and long term technical and clinical outcomes and to identify risk factors for stent dysfunction.

Results 118 ECE-LAMS EUS guided biliary drainage for distal malignant biliary obstruction (pancreatic adenocarcinoma in 77% of cases) were included. The median bilirubin level before drainage was 277µmol/L with a median bile duct dilation of 18mm.

Technical success was achieved in 97.43% of cases, with clinical success in 95.72% of cases.

The rate of stent dysfunction during in the follow-up was 16.10%, with a significantly increased risk in multivariate analysis for cholangiocarcinoma (OR=4,6 [1,2-51,4], p=0,011), the presence of a duodenal stent (OR=4,5 [1,1-15,6], p=0,002) and a bile duct diameter less than 14mm in pre-procedure (OR=4.395, [1.27-15.16], p=0.019)

Conclusions Our study confirms the high technical and clinical success rate of EUS guided biliary drainage with ECE-LAMS. Rate of stent dysfunction during follow-up was 16%. A bile duct diameter of less than 14 mm, the presence of a duodenal stent and the presence of a distal cholangiocarcinoma constitute risk factors for stent dysfunction during the follow-up.

Publication History

Article published online:
14 April 2022