Lumen apposing metal stents versus tubular self-expandable metal stents for endoscopic ultrasound-guided choledochoduode
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and Other Interventional Techniques
Lumen apposing metal stents versus tubular self‑expandable metal stents for endoscopic ultrasound‑guided choledochoduodenostomy in malignant biliary obstruction Marina de Benito Sanz1 · Rodrigo Nájera‑Muñoz1 · Carlos de la Serna‑Higuera1 · Esteban Fuentes‑Valenzuela1 · Ignacio Fanjul1 · Carlos Chavarría1 · Francisco Javier García‑Alonso1 · Ramón Sanchez‑Ocana1 · Ana Yaiza Carbajo1 · Sergio Bazaga1 · Manuel Perez‑Miranda1 Received: 8 July 2020 / Accepted: 15 November 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Background and aims EUS-guided choledochoduodenostomy (EUS-CDS) is an effective option for biliary drainage in malignant biliary obstruction. Lumen apposing metal stents (LAMS) are increasingly been used for EUS-CDS. It is unknown how LAMS compare to tubular self-expandable metal stents (SEMS) for EUS-CDS. Our aim is to compare the clinical outcomes of LAMS versus SEMS for EUS-CDS. Patients and methods Single-center retrospective cohort study of consecutive patients with unresectable malignant biliary obstruction who underwent EUS-CDS after failed ERCP for initial biliary drainage between 2011 and 2019. Clinical outcomes were compared between patients who had conventional covered SEMS and LAMS placed for EUS-CDS. Outcome measures included unplanned procedural events, technical success, clinical success, adverse events and reinterventions. Survival was analyzed by the Kaplan–Meier method. Results During the study period 57 patients met inclusion criteria (37 LAMS, 20 SEMS). All EUS-CDS were technically successful (LAMS group 95% CI 90.3–100%, SEMS group 95% CI 83.2–100%). There were no differences between groups in unplanned procedural events (4 LAMS deployment issues, 2 mild bleeding in SEMS group; 10 vs 10.8%), clinical success (37/37 [100%] vs 19/20 [95%]), and short-term adverse events (5/37 [13.5%] vs 4/20 [20%], p = 0.71). Complete follow-up data were available in 41 patients for a mean of 376 ± 145 days. Endoscopic reintervention was required for duodenal stent placement (n = 9) or biliary stent dysfunction (n = 4), with no difference between LAMS and SEMS group (6/37 [16.2%] vs 7/20 [35%]). There were no differences in overall survival between both groups. Conclusions EUS-guided choledochoduodenostomy after failed ERCP has equally high technical and clinical success rates with either LAMS or SEMS in patients with malignant biliary obstruction. No differences in adverse events, reinterventions and survival were seen with either type of stent. The cost-effectiveness of LAMS vs SEMS for EUS-guided choledochoduodenostomy remains to be proven. Keywords Lumen apposing metal stent (LAMS) · Biliary drainage (EUS-BD) · EUS-guided choledochoduodenostomy · Malignant biliary obstruction · Self-expandable metal stent (SEMS) Malignant tumors involving the bile duct typically present with obstructive jaundice. Persistent obstructive jaundice impairs patient quality of life and may potentially lead to serious complications, including live
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