Eus-Guided Choledochoduodenostomy Using a Lumen-Apposing Metal Stent for Malignant Distal Biliary Obstruction: a Retrospective Multicenter Analysis

A Fugazza; C Fabbri; R Di Mitri; MC Petrone; M Colombo; M Ballarè; L Cugia; A Amato; E Forti; G De Nucci; M Manno; V Pollino; C Binda; R Macchiarelli; N Leone; R Badas; M Lovera; E Armellini; A Redaelli; B Mangiavillano; ML Brancaccio; F Attili; T Togliani; G Aragona; E Conte; M Maida; E Sinagra; A Repici; I Tarantino; A Anderloni

doi:10.1055/s-0041-1724356

Endoscopy, Table of Contents

Endoscopy 2021; 53(S 01): S41-S42
DOI: 10.1055/s-0041-1724356

Abstracts | ESGE Days

ESGE Days 2021 Oral presentations

Friday, 26 March 2021 10:00 – 10:45 Transduodenal EUS biliary approach: The best way? Room 6

Eus-Guided Choledochoduodenostomy Using a Lumen-Apposing Metal Stent for Malignant Distal Biliary Obstruction: a Retrospective Multicenter Analysis

Authors

A Fugazza

¹Humanitas Clinical and Research Center - IRCCS, Digestive Endoscopy Unit, Rozzano, Italy
C Fabbri

²Forlì-Cesena Hospital, Gastroenterology and Digestive Endoscopy Unit, Forlì-Cesena, Italy
R Di Mitri

³ARNAS Civico Hospital, Gastroenterology and Endoscopy Unit, Palermo, Italy
MC Petrone

⁴San Raffaele Scientific Institute - IRCCS, PancreatoBiliary Endoscopy and EUS Division, Milano, Italy
M Colombo

¹Humanitas Clinical and Research Center - IRCCS, Digestive Endoscopy Unit, Rozzano, Italy
M Ballarè

⁵Maggiore della Carità Hospital, Department of Gastroenterology, Novara, Italy
L Cugia

⁶Azienda Ospedaliero Universitaria Sassari, Gastroenterology and Digestive Endoscopy Department, Sassari, Italy
A Amato

⁷Valduce Hospital, Department of Gastroenterology, Como, Italy
E Forti

⁸Ospedale Ca’ Granda Niguarda, Digestive and Interventional Endoscopy Unit, Milano, Italy
G De Nucci

⁹Guido Salvini Hospital, Department of Gastroenterology, Garbagnate Milanese, Italy
M Manno

¹⁰Carpi Hospital, Gastroenterology and Digestive Endoscopy Unit, Carpi, Italy
V Pollino

¹¹Brotzu Hospital, Department of Endoscopic Surgery, Cagliari, Italy
C Binda

²Forlì-Cesena Hospital, Gastroenterology and Digestive Endoscopy Unit, Forlì-Cesena, Italy
R Macchiarelli

¹²Policlinico S. Maria alle Scotte, Gastroenterology Unit, Siena, Italy
N Leone

¹³Humanitas - Gradenigo, Digestive Endoscopy Unit, Torino, Italy
R Badas

¹⁴University Hospital, Digestive Endoscopy Unit, Cagliari, Italy
M Lovera

¹⁵Fondazione Poliambulanza Istituto Ospedaliero, Digestive Endoscopy Unit, Brescia, Italy
E Armellini

¹⁶ASST Bergamo Est, Digestive Endoscopy Unit, Seriate, Italy
A Redaelli

¹⁷San Gerardo Hospital, Gastroenterology and Endoscopy Unit, Monza, Italy
B Mangiavillano

¹⁸Humanitas - Mater Domini, Gastrointestinal Endoscopy Unit, Castellanza, Italy
ML Brancaccio

¹⁹S. Maria delle Croci Hospital, Division of Gastroenterology, Ravenna, Italy
F Attili

²⁰Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Digestive Endoscopy Unit, Roma, Italy
T Togliani

²¹ASST Carlo Poma, Gastroenterology and Endoscopy Unit, Mantova, Italy
G Aragona

²²Guglielmo da Saliceto Hospital, Department of Internal Medicine, Piacenza, Italy
E Conte

³ARNAS Civico Hospital, Gastroenterology and Endoscopy Unit, Palermo, Italy
M Maida

²³S. Elia-Raimondi Hospital, Gastroenterology and Endoscopy Unit, Caltanissetta, Italy
E Sinagra

²⁴Fondazione Istituto San Raffaele Giglio, Gastroenterology and Endoscopy Unit, Cefalù, Italy
A Repici

¹Humanitas Clinical and Research Center - IRCCS, Digestive Endoscopy Unit, Rozzano, Italy
I Tarantino

²⁵IRCCS-ISMETT, Endoscopy Service, Department of Diagnostic and Therapeutic Services, Palermo, Italy
A Anderloni

¹Humanitas Clinical and Research Center - IRCCS, Digestive Endoscopy Unit, Rozzano, Italy

Abstract

Full Text

Aims Endoscopic ultrasound-guided choledochoduodenostomy (EUS-CDS) with lumen apposing metal stent (LAMS) has emerged as a procedure with encouraging results in terms of safety and effectiveness in patients with malignant distal biliary obstruction and failed endoscopic retrograde cholangiopancreatography (ERCP).

Methods This is a multicenter, retrospective analysis including all cases of EUS-CDS with LAMS performed in patients with malignant distal biliary obstruction and failed ERCP in 23 Italian Centers from February 2015 to July 2020.

Primary endpoints were technical and clinical success. Secondary endpoint was the adverse events (AEs) rate.

Results A total of 256 patients (55.1 % males) with a mean age of 73.6 ± 12.4 were included in the study. The most common etiology of biliary stricture was pancreatic adenocarcinoma (75.4 %), followed by ampullary cancer (8.6 %) and cholangiocarcinoma (7.0 %). The common bile duct median diameter was 17.0 ± 4.0 mm. Technical and clinical success were achieved in 93.0 % and 89.5 % of cases respectively, with a mean bilirubin reduction at two weeks of 73 %. Median procedure time was 28.0 minutes. The mean follow-up was 148.1 days. Forty-nine AEs (13 mild, 28 moderate and 8 severe) occurred in 46 patients (18 %) and were classified as intraprocedural 21 (42.9 %), early < 15 days 10 (20.4 %), delayed > 15 days 18 (37.6 %). No fatal AE occurred.

Conclusions The results of our study show that EUS-guided biliary drainage with LAMS in case of malignant distal biliary obstruction in patients with failed ERCP represents a viable alternative in terms of effectiveness, safety and long-term result with an acceptable adverse event rate. To the best of our knowledge this is the largest study in the literature concerning this procedure.

Citation: Fugazza A, Fabbri C, Di Mitri R et al. OP97 EUS-GUIDED CHOLEDOCHODUODENOSTOMY USING A LUMEN-APPOSING METAL STENT FOR MALIGNANT DISTAL BILIARY OBSTRUCTION: A RETROSPECTIVE MULTICENTER ANALYSIS. Endoscopy 2021; 53: S41.