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Inoue T, Ibusuki M, Kitano R, Ito K. Endoscopic ultrasound-guided choledochoduodenostomy using a novel, ultra-stiff, high-sliding guidewire and a dumbbell-shaped metal stent. Endoscopy 2024; 56:E140-E141. [PMID: 38359881 PMCID: PMC10869224 DOI: 10.1055/a-2241-2030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Affiliation(s)
- Tadahisa Inoue
- Department of Gastroenterology, Aichi Medical University, Nagakute, Japan
| | - Mayu Ibusuki
- Department of Gastroenterology, Aichi Medical University, Nagakute, Japan
| | - Rena Kitano
- Department of Gastroenterology, Aichi Medical University, Nagakute, Japan
| | - Kiyoaki Ito
- Department of Gastroenterology, Aichi Medical University, Nagakute, Japan
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2
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Vanella G, Frigo F, Arcidiacono PG. Endoscopic ultrasound-guided gallbladder drainage for jaundice: Second-line strategy with a strict entry selection. Dig Endosc 2024. [PMID: 38926137 DOI: 10.1111/den.14876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2024] [Accepted: 06/06/2024] [Indexed: 06/28/2024]
Affiliation(s)
- Giuseppe Vanella
- Pancreatobiliary Endoscopy and Endosonography Division, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesco Frigo
- Pancreatobiliary Endoscopy and Endosonography Division, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Paolo Giorgio Arcidiacono
- Pancreatobiliary Endoscopy and Endosonography Division, IRCCS San Raffaele Scientific Institute, Milan, Italy
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3
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Li JS, Tang J, Fang J, Li ZS, Liu F. Adverse events in endoscopic ultrasound-guided choledochoduodenostomy with lumen-apposing metal stents: A systematic review and meta-analysis. J Gastroenterol Hepatol 2024. [PMID: 38736198 DOI: 10.1111/jgh.16614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 02/01/2024] [Accepted: 05/01/2024] [Indexed: 05/14/2024]
Abstract
BACKGROUND AND AIM Several meta-analyses have analyzed the technical and clinical success of endoscopic ultrasound-guided choledochoduodenostomy (EUS-CDS) by using lumen-apposing metal stents (LAMS) in malignant biliary obstruction, but those concerning adverse events (AEs) are scarce. The current systematic review and meta-analysis was conducted to evaluate the AEs after EUS-CDS with LAMS. METHODS A comprehensive literature search of PubMed, Embase, Scopus, Web of Science, and the Cochrane Library was conducted for studies reporting the outcomes of EUS-CDS with LAMS. The main endpoints were the incidence of overall and specific AEs. Moreover, the stent dysfunction, and reintervention rates were evaluated independently. RESULTS A total of 21 studies (n = 1438) were included in the final meta-analysis. The pooled rate of technical and clinical success was 93.5% (95% confidence interval [CI]: 91.3-95.1) and 88.0% (95% CI: 83.9-91.1), respectively. After EUS-CDS with LAMS, the pooled incidence of overall AEs was 20.1% (95% CI: 16.0-24.9). The estimated rate of early AEs was 10.6% (95% CI: 7.9-14.2), and late AEs was 11.2% (95% CI: 8.2-15.2). Infection/cholangitis was the commonest AE, with a pooled incidence of 6.1% (95% CI: 3.7-10.1). The estimated incidence of stent dysfunction and reintervention was 10.5% (95% CI: 7.5-14.4), and 12.1% (95% CI: 9.3-15.7), respectively. CONCLUSION Despite with a high technical and clinical success rate, EUS-CDS with LAMS may be associated with overall AEs and stent dysfunction in one-fifth and one-tenth of cases, respectively. Further efforts are required to optimize its safety and long-term stent patency.
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Affiliation(s)
- Jia-Su Li
- Department of Gastroenterology, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Jian Tang
- Digestive Endoscopy Center, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Jun Fang
- Department of Gastroenterology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Zhao-Shen Li
- Department of Gastroenterology, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Feng Liu
- Digestive Endoscopy Center, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
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4
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Albouys J, Guilmoteau T, Schaefer M, Jacques J. How to prevent and treat biliary lumen-apposing metal stent dysfunction? Dig Endosc 2024; 36:492-494. [PMID: 38514464 DOI: 10.1111/den.14787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 02/18/2024] [Indexed: 03/23/2024]
Affiliation(s)
- Jérémie Albouys
- Department of Gastroenterology and Digestive Endoscopy, Dupuytren University Hospital, Limoges, France
| | - Thomas Guilmoteau
- Department of Digestive Medicine, Estaing University Hospital, Clermont-Ferrand, France
| | - Marion Schaefer
- Department of Gastroenterology and Digestive Endoscopy, Nancy University Hospital, Nancy, France
| | - Jérémie Jacques
- Department of Gastroenterology and Digestive Endoscopy, Dupuytren University Hospital, Limoges, France
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5
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Vanella G, Dell'Anna G, van Wanrooij RLJ, Bronswijk M, Voermans RP, Laleman W, van Malenstein H, Fockens P, Van der Merwe S, Arcidiacono PG. Managing dysfunctions and reinterventions in endoscopic ultrasound-guided choledochoduodenostomy with lumen apposing metal stents: Illustrated technical review (with videos). Dig Endosc 2024; 36:481-491. [PMID: 37852797 DOI: 10.1111/den.14708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 10/15/2023] [Indexed: 10/20/2023]
Abstract
Endoscopic ultrasound-guided choledochoduodenostomy (EUS-CDS) with lumen apposing metal stent is emerging both as a rescue strategy and a primary treatment for distal malignant biliary obstruction. The large-scale diffusion of the procedure and improved overall survival of patients with pancreatobiliary neoplasms is resulting in a growing population of long-term EUS-CDS lumen apposing metal stent carriers. Recent studies have reported a need for reintervention during follow-up as high as 55%, and the Leuven-Amsterdam-Milan Study Group classification has been developed, identifying five mechanisms of stent dysfunction and 11 possible rescue strategies aimed at restoring biliary drainage. This illustrated technical review aims to further dissect the recent classification through a comprehensive analysis of nine illustrative cases, offering insights into the pathophysiology underlying dysfunction and clinical reasoning behind rescue interventions, as well as technical considerations and practical tips and tricks. By exploring mechanisms of dysfunction, this review also assists clinicians in selecting the ideal candidates for EUS-CDS while identifying patients deemed high risk for dysfunction or clinical failure.
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Affiliation(s)
- Giuseppe Vanella
- Pancreatobiliary Endoscopy and Endosonography Division, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Giuseppe Dell'Anna
- Pancreatobiliary Endoscopy and Endosonography Division, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Roy L J van Wanrooij
- Department of Gastroenterology and Hepatology, Amsterdam Gastroenterology Endocrinology and Metabolism, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - Michiel Bronswijk
- Department of Gastroenterology and Hepatology, University Hospitals Gasthuisberg, University of Leuven, Leuven, Belgium
- Department of Gastroenterology and Hepatology, Imelda General Hospital, Bonheiden, Belgium
| | - Rogier P Voermans
- Department of Gastroenterology and Hepatology, Amsterdam Gastroenterology Endocrinology and Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Wim Laleman
- Department of Gastroenterology and Hepatology, Amsterdam Gastroenterology Endocrinology and Metabolism, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - Hannah van Malenstein
- Department of Gastroenterology and Hepatology, Amsterdam Gastroenterology Endocrinology and Metabolism, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - Paul Fockens
- Department of Gastroenterology and Hepatology, Amsterdam Gastroenterology Endocrinology and Metabolism, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
- Department of Gastroenterology and Hepatology, Amsterdam Gastroenterology Endocrinology and Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Schalk Van der Merwe
- Department of Gastroenterology and Hepatology, Amsterdam Gastroenterology Endocrinology and Metabolism, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - Paolo Giorgio Arcidiacono
- Pancreatobiliary Endoscopy and Endosonography Division, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
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6
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Fabbri C, Scalvini D, Paolo G, Binda C, Mauro A, Coluccio C, Mazza S, Trebbi M, Torello Viera F, Anderloni A. Complications and management of interventional endoscopic ultrasound: A critical review. Best Pract Res Clin Gastroenterol 2024; 69:101888. [PMID: 38749575 DOI: 10.1016/j.bpg.2024.101888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Accepted: 01/30/2024] [Indexed: 07/13/2024]
Abstract
In the last decades, Endoscopic ultrasound (EUS) has rapidly grown and evolved from being mainly a diagnostic procedure, to being an interventional and therapeutic tool in several pathological clinical scenarios. With the progressive growth in technical expertise and dedicated devices, interventional endoscopic ultrasound procedures (IEUSP) have shown high rates of technical and clinical success, together with a relatively safe profile. However, the description and the standardization of different and specific types of adverse events (AEs) are still scarce in literature, and, consequently, even less the management of AEs. The aim of this study is to critical review and to describe AEs related to each of the main IEUSP, and to provide an overview on the possible management strategies of endoscopic complications. Future studies and guidelines are surely required to reach a better standardization of different AEs and their best management.
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Affiliation(s)
- Carlo Fabbri
- Gastroenterology and Digestive Endoscopy Unit, Forlì-Cesena Hospitals, AUSL Romagna, Forlì, Italy
| | - Davide Scalvini
- Gastroenterology and Digestive Endoscopy Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy
| | - Giuffrida Paolo
- Gastroenterology and Digestive Endoscopy Unit, Forlì-Cesena Hospitals, AUSL Romagna, Forlì, Italy.
| | - Cecilia Binda
- Gastroenterology and Digestive Endoscopy Unit, Forlì-Cesena Hospitals, AUSL Romagna, Forlì, Italy
| | - Aurelio Mauro
- Gastroenterology and Digestive Endoscopy Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Chiara Coluccio
- Gastroenterology and Digestive Endoscopy Unit, Forlì-Cesena Hospitals, AUSL Romagna, Forlì, Italy
| | - Stefano Mazza
- Gastroenterology and Digestive Endoscopy Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Margherita Trebbi
- Gastroenterology and Digestive Endoscopy Unit, Forlì-Cesena Hospitals, AUSL Romagna, Forlì, Italy
| | - Francesca Torello Viera
- Gastroenterology and Digestive Endoscopy Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Andrea Anderloni
- Gastroenterology and Digestive Endoscopy Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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7
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Li JS, Tang J, Liu F. Endoscopic Ultrasound-Guided Choledochoduodenostomy Using Lumen-Apposing Metal Stents vs Endoscopic Retrograde Cholangiopancreatography: Further Efforts Are Required. Gastroenterology 2024; 166:538-539. [PMID: 37604240 DOI: 10.1053/j.gastro.2023.08.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 08/15/2023] [Indexed: 08/23/2023]
Affiliation(s)
- Jia-Su Li
- Department of Gastroenterology, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Jian Tang
- Digestive Endoscopy Center, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Feng Liu
- Digestive Endoscopy Center, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
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8
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Nakai Y. Can endoscopic ultrasound-guided gallbladder drainage be an alternative biliary drainage in all cases after failed endoscopic retrograde cholangiopancreatography? Dig Endosc 2024. [PMID: 38414388 DOI: 10.1111/den.14760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Accepted: 01/09/2024] [Indexed: 02/29/2024]
Affiliation(s)
- Yousuke Nakai
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Department of Endoscopy and Endoscopic Surgery, The University of Tokyo Hospital, Tokyo, Japan
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9
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Debourdeau A, Daniel J, Caillo L, Assenat E, Bertrand M, Bardol T, Souche FR, Pouderoux P, Gerard R, Lorenzo D, Bourgaux JF. Effectiveness of endoscopic ultrasound (EUS)-guided choledochoduodenostomy vs. EUS-guided gallbladder drainage for jaundice in patients with malignant distal biliary obstruction after failed endoscopic retrograde cholangiopancreatography: Retrospective, multicenter study (GALLBLADEUS Study). Dig Endosc 2024. [PMID: 38380564 DOI: 10.1111/den.14750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 12/24/2023] [Indexed: 02/22/2024]
Abstract
OBJECTIVES The aim of this study was to compare endoscopic ultrasound-guided choledochoduodenostomy (EUS-CDS) vs. EUS-gallbladder drainage (EUS-GBD) in cases of failed endoscopic retrograde cholangiopancreatography (ERCP) for jaundice resulting from malignant distal biliary obstruction (MDBO). METHODS This multicenter retrospective study included patients with obstructive jaundice secondary to MDBO who underwent EUS-GBD or EUS-CDS with lumen-apposing metal stents after failed ERCP. The primary end-point was clinical success rate. Secondary end-points were technical success, periprocedural adverse events rate (<24 h), late adverse events rate (>24 h), overall survival, and time to recurrent biliary obstruction. RESULTS A total of 78 patients were included: 41 underwent EUS-GBD and 37 underwent EUS-CDS. MDBO was mainly the result of pancreatic cancer (n = 63/78, 80.7%). Clinical success rate was similar for both procedures: 87.8% for EUS-GBD and 89.2% for EUS-CDS (P = 0.8). Technical success rate was 100% for EUS-GBD and 94.6% for EUS-CDS (P = 0.132). Periprocedural morbidity (<24 h) rates were similar between both groups: 4/41 (9.8%) for EUS-GBD and 5/37 (13.5%) for EUS-CDS (P = 0.368). There was a significantly higher rate of late morbidity (>24 h) among patients in the EUS-CDS group (8/37 [21.6%]) than in the EUS-GBD group (3/41 [7.3%]) (P = 0.042). The median follow-up duration was 4.7 months. Overall survival and time to recurrent biliary obstruction did not significantly differ between the groups. DISCUSSION After failed ERCP for MDBO, EUS-GBD and EUS-CDS show comparable clinical success rates and technical success. EUS-GBD appears to be a promising alternative for MDBO, even as a second-line treatment after failed ERCP. Further studies are needed to validate these findings and compare the long-term outcomes of EUS-GBD and EUS-CDS.
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Affiliation(s)
- Antoine Debourdeau
- Hepatogastroenterology Department, Nimes University Hospital, University of Montpellier, Nimes, France
- Hepatogastroenterology Department, Montpellier University Hospital, University of Montpellier, Montpellier, France
| | - Jules Daniel
- Hepatogastroenterology Department, Nimes University Hospital, University of Montpellier, Nimes, France
| | - Ludovic Caillo
- Hepatogastroenterology Department, Nimes University Hospital, University of Montpellier, Nimes, France
| | - Eric Assenat
- Hepatogastroenterology Department, Montpellier University Hospital, University of Montpellier, Montpellier, France
| | - Martin Bertrand
- Surgery Department, Nimes University Hospital, University of Montpellier, Nimes, France
| | - Thomas Bardol
- Surgery Department, Montpellier University Hospital, University of Montpellier, Montpellier, France
| | - François-Régis Souche
- Surgery Department, Montpellier University Hospital, University of Montpellier, Montpellier, France
| | - Philippe Pouderoux
- Hepatogastroenterology Department, Nimes University Hospital, University of Montpellier, Nimes, France
| | - Romain Gerard
- Hepatogastroenterology Department, Lille University Hospital, Lille University, Lille, France
| | - Diane Lorenzo
- Hepatogastroenterology Department, Beaujon University Hospital, Paris Cité University, Paris, France
| | - Jean-François Bourgaux
- Hepatogastroenterology Department, Nimes University Hospital, University of Montpellier, Nimes, France
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10
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Guilmoteau T, Albouys J, Taibi A, Legros R, Schaefer M, Jacques J. Will Endoscopic-Ultrasound-Guided Choledocoduodenostomy with Electrocautery-Enhanced Lumen-Apposing Metal Stent Placement Replace Endoscopic Retrograde Cholangiopancreatography When Treating Distal Malignant Biliary Obstructions? MEDICINA (KAUNAS, LITHUANIA) 2024; 60:220. [PMID: 38399508 PMCID: PMC10889952 DOI: 10.3390/medicina60020220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Revised: 01/09/2024] [Accepted: 01/25/2024] [Indexed: 02/25/2024]
Abstract
Malignant distal biliary obstructions are becoming increasingly common, especially in patients with cancers of the pancreatic head, despite progress in medical oncology research. ERCP is the current gold standard for management of such strictures, but the emergence of EC-LAMS has rendered EUS-CDS both safe and efficient. It is a "game changer"; originally intended for ERCP failure, two randomised clinical trials recently proposed EUS-CDS as a first-intent procedure in palliative settings. For resectable diseases, the absence of iatrogenic pancreatitis associated with a lower rate of postsurgical adverse events (compared with ERCP) leads us to believe that EUS-CDS might be used in first-intent as a pre-operative endoscopic biliary drainage.
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Affiliation(s)
- Thomas Guilmoteau
- Hepatogastroenterology, Centre Hospitalier Universitaire Dupuytren, 87000 Limoges, France; (T.G.); (J.A.); (A.T.); (R.L.)
| | - Jérémie Albouys
- Hepatogastroenterology, Centre Hospitalier Universitaire Dupuytren, 87000 Limoges, France; (T.G.); (J.A.); (A.T.); (R.L.)
| | - Abdelkader Taibi
- Hepatogastroenterology, Centre Hospitalier Universitaire Dupuytren, 87000 Limoges, France; (T.G.); (J.A.); (A.T.); (R.L.)
| | - Romain Legros
- Hepatogastroenterology, Centre Hospitalier Universitaire Dupuytren, 87000 Limoges, France; (T.G.); (J.A.); (A.T.); (R.L.)
| | - Marion Schaefer
- Hepatogastroenterology, Nancy Regional University Hospital Center, 54500 Nancy, France;
| | - Jérémie Jacques
- Hepatogastroenterology, Centre Hospitalier Universitaire Dupuytren, 87000 Limoges, France; (T.G.); (J.A.); (A.T.); (R.L.)
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11
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Barthet M. Endoscopic ultrasound-guided choledochoduodenostomy: is the rate of stent dysfunction underestimated? Endoscopy 2024; 56:53-55. [PMID: 37963571 DOI: 10.1055/a-2193-5791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Affiliation(s)
- Marc Barthet
- Department of gastroenterology, Hopital Nord, Marseille cedex 20, France
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12
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Fritzsche JA, Van Wanrooij RLJ, Voermans RP. EUS-guided Choledochoduodenostomy: Taking the Shortcut, But Still a Long Way to Go. Gastroenterology 2024; 166:216-217. [PMID: 37290702 DOI: 10.1053/j.gastro.2023.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 06/02/2023] [Indexed: 06/10/2023]
Affiliation(s)
- Jeska A Fritzsche
- Department of Gastroenterology and Hepatology, Amsterdam UMC, location University of Amsterdam, and, Amsterdam Gastroenterology Endocrinology Metabolism and, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Roy L J Van Wanrooij
- Department of Gastroenterology and Hepatology, Amsterdam UMC, location Vrije Universiteit, and, Amsterdam Gastroenterology Endocrinology Metabolism and, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Rogier P Voermans
- Department of Gastroenterology and Hepatology, Amsterdam UMC, location University of Amsterdam, and, Amsterdam Gastroenterology Endocrinology Metabolism and, Cancer Center Amsterdam, Amsterdam, The Netherlands
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13
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Fritzsche JA, Fockens P, Besselink MG, Busch OR, Daams F, Montazeri NSM, Wilmink JW, Voermans RP, Van Wanrooij RLJ. Endoscopic ultrasound-guided choledochoduodenostomy using single-step lumen-apposing metal stents for primary drainage of malignant distal biliary obstruction (SCORPION-p): a prospective pilot study. Endoscopy 2024; 56:47-52. [PMID: 37473780 DOI: 10.1055/a-2134-3537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/22/2023]
Abstract
BACKGROUND This study aimed to assess the safety and feasibility of endoscopic ultrasound-guided choledochoduodenostomy (EUS-CDS) using a lumen-apposing metal stent (LAMS) as a primary drainage strategy in patients with distal malignant biliary obstruction (MBO). METHODS A prospective, single-center, pilot study was conducted in patients with pathology-confirmed MBO without gastric outlet obstruction. The primary outcome was technical success. Secondary outcomes included clinical success, adverse events (AEs), and reinterventions. The study was registered in the Netherlands Trial Registry (registry number NL9757). RESULTS 22 patients were enrolled (median age 69.5 years [interquartile range 64-75.3]). Technical success was achieved in 20/22 patients (91 %). AEs occurred in one patient, namely perforation following inadequate stent deployment (5 %), which was treated in the same procedure. Clinical success was achieved in 19/22 patients (86 %). Stent dysfunction was observed in 11/20 patients (55 %) after technically successful EUS-CDS: two patients were treated conservatively and nine patients underwent reintervention(s). One patient died within ≤ 30 days due to fulminant disease progression. CONCLUSIONS The results confirmed the safety and feasibility of EUS-CDS using LAMS as a primary drainage strategy. The high incidence of stent dysfunction should be improved before EUS-CDS with LAMS can be seen as a valid alternative to endoscopic retrograde cholangiopancreatography.
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Affiliation(s)
- Jeska A Fritzsche
- Department of Gastroenterology and Hepatology, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Gastroenterology Endocrinology Metabolism, Research Institute, Amsterdam, The Netherlands
- Treatment and Quality of life, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Paul Fockens
- Department of Gastroenterology and Hepatology, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Gastroenterology Endocrinology Metabolism, Research Institute, Amsterdam, The Netherlands
- Treatment and Quality of life, Cancer Center Amsterdam, Amsterdam, The Netherlands
- Department of Gastroenterology and Hepatology, Amsterdam UMC, location Vrije Universiteit, Amsterdam, The Netherlands
| | - Marc G Besselink
- Amsterdam Gastroenterology Endocrinology Metabolism, Research Institute, Amsterdam, The Netherlands
- Treatment and Quality of life, Cancer Center Amsterdam, Amsterdam, The Netherlands
- Department of Surgery, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands
| | - Olivier R Busch
- Amsterdam Gastroenterology Endocrinology Metabolism, Research Institute, Amsterdam, The Netherlands
- Treatment and Quality of life, Cancer Center Amsterdam, Amsterdam, The Netherlands
- Department of Surgery, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands
| | - Freek Daams
- Amsterdam Gastroenterology Endocrinology Metabolism, Research Institute, Amsterdam, The Netherlands
- Treatment and Quality of life, Cancer Center Amsterdam, Amsterdam, The Netherlands
- Department of Surgery, Amsterdam UMC, location Vrije Universiteit, Amsterdam, The Netherlands
| | - Nahid S M Montazeri
- Amsterdam Gastroenterology Endocrinology Metabolism, Research Institute, Amsterdam, The Netherlands
- Department of Gastroenterology and Hepatology, Biostatistics Unit, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands
| | - Johanna W Wilmink
- Amsterdam Gastroenterology Endocrinology Metabolism, Research Institute, Amsterdam, The Netherlands
- Treatment and Quality of life, Cancer Center Amsterdam, Amsterdam, The Netherlands
- Department of Medical Oncology, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands
| | - Rogier P Voermans
- Department of Gastroenterology and Hepatology, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Gastroenterology Endocrinology Metabolism, Research Institute, Amsterdam, The Netherlands
- Treatment and Quality of life, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Roy L J Van Wanrooij
- Amsterdam Gastroenterology Endocrinology Metabolism, Research Institute, Amsterdam, The Netherlands
- Treatment and Quality of life, Cancer Center Amsterdam, Amsterdam, The Netherlands
- Department of Gastroenterology and Hepatology, Amsterdam UMC, location Vrije Universiteit, Amsterdam, The Netherlands
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14
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Garcia-Sumalla A, Quintana-Carbo S, Gornals JB. Specialized coaxial hepaticogastrostomy stent and lumen-apposing stent for salvage of dysfunctional EUS-guided cholecochoduodenostomy. Endoscopy 2023; 55:E611-E612. [PMID: 37040882 PMCID: PMC10089798 DOI: 10.1055/a-2055-1200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/13/2023]
Affiliation(s)
- Albert Garcia-Sumalla
- Endoscopy Unit, Department of Digestive Diseases, Hospital Universitari de Bellvitge, Barcelona, Catalonia, Spain
- Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Catalonia, Spain
- Universitat de Barcelona, Barcelona, Catalonia, Spain
| | - Sergi Quintana-Carbo
- Endoscopy Unit, Department of Digestive Diseases, Hospital Universitari de Bellvitge, Barcelona, Catalonia, Spain
- Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Catalonia, Spain
- Universitat de Barcelona, Barcelona, Catalonia, Spain
| | - Joan B Gornals
- Endoscopy Unit, Department of Digestive Diseases, Hospital Universitari de Bellvitge, Barcelona, Catalonia, Spain
- Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Catalonia, Spain
- Universitat de Barcelona, Barcelona, Catalonia, Spain
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15
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On W, Ahmed W, Everett S, Huggett M, Paranandi B. Utility of interventional endoscopic ultrasound in pancreatic cancer. Front Oncol 2023; 13:1252824. [PMID: 37781196 PMCID: PMC10540845 DOI: 10.3389/fonc.2023.1252824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 08/30/2023] [Indexed: 10/03/2023] Open
Abstract
Endoscopic ultrasound (EUS) has an important role in the management algorithm of patients with pancreatic ductal adenocarcinoma (PDAC), typically for its diagnostic utilities. The past two decades have seen a rapid expansion of the therapeutic capabilities of EUS. Interventional EUS is now one of the more exciting developments within the field of endoscopy. The local effects of PDAC tend to be in anatomical areas which are difficult to target and endoscopy has cemented itself as a key role in managing the clinical sequelae of PDAC. Interventional EUS is increasingly utilized in situations whereby conventional endoscopy is either impossible to perform or unsuccessful. It also adds a different dimension to the host of oncological and surgical treatments for patients with PDAC. In this review, we aim to summarize the various ways in which interventional EUS could benefit patients with PDAC and aim to provide a balanced commentary on the current evidence of interventional EUS in the literature.
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Affiliation(s)
- Wei On
- Department of Gastroenterology, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
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16
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Gornals JB, Garcia-Sumalla A, Puigcerver-Mas M. Conversion of a dysfunctional choledochoduodenostomy to transpapillary drainage via a trans-lumen-apposing metal stent choledochoduodenoscopy. VIDEOGIE : AN OFFICIAL VIDEO JOURNAL OF THE AMERICAN SOCIETY FOR GASTROINTESTINAL ENDOSCOPY 2023; 8:361-363. [PMID: 37719953 PMCID: PMC10500156 DOI: 10.1016/j.vgie.2023.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 09/19/2023]
Abstract
Video 1Peroral antegrade cholangioscopy-guided conversion of dysfunctional choledochoduodenostomy to transpapillary drainage via trans-LAMS (lumen-apposing metal stent).
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Affiliation(s)
- Joan B Gornals
- Endoscopy Unit, Digestive Diseases Department, Hospital Universitari de Bellvitge, Barcelona, Catalonia, Spain
- Universitat de Barcelona, Barcelona, Catalonia, Spain
- Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Catalonia, Spain
| | - Albert Garcia-Sumalla
- Endoscopy Unit, Digestive Diseases Department, Hospital Universitari de Bellvitge, Barcelona, Catalonia, Spain
- Universitat de Barcelona, Barcelona, Catalonia, Spain
- Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Catalonia, Spain
| | - Maria Puigcerver-Mas
- Endoscopy Unit, Digestive Diseases Department, Hospital Universitari de Bellvitge, Barcelona, Catalonia, Spain
- Universitat de Barcelona, Barcelona, Catalonia, Spain
- Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Catalonia, Spain
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17
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Armellini E, Metelli F, Anderloni A, Cominardi A, Aragona G, Marini M, Pace F. Lumen-apposing-metal stent misdeployment in endoscopic ultrasound-guided drainages: A systematic review focusing on issues and rescue management. World J Gastroenterol 2023; 29:3341-3361. [PMID: 37377584 PMCID: PMC10292149 DOI: 10.3748/wjg.v29.i21.3341] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 02/01/2023] [Accepted: 05/06/2023] [Indexed: 06/01/2023] Open
Abstract
BACKGROUND The introduction of lumen-apposing metal stents (LAMS) for endoscopic ultrasound (EUS)-guided drainages has marked a turning point in the field of interventional ultrasound and it is gathering worldwide diffusion in different clinical settings. Nevertheless, the procedure may conceal unexpected pitfalls. LAMS misdeployment is the most frequent cause of technical failure and it can be considered a procedure-related adverse event when it hampers the conclusion of the planned procedure or results in significant clinical consequences. Stent misdeployment can be managed successfully by endoscopic rescue maneuvers to allow the completion of the procedure. To date, no standardized indication is available to guide an appropriate rescue strategy depending on the type of procedure or of misdeployment.
AIM To evaluate the incidence of LAMS misdeployment during EUS-guided choledochoduodenostomy (EUS-CDS), gallbladder drainage (EUS-GBD) and pancreatic fluid collections drainage (EUS-PFC) and to describe the endoscopic rescue strategies adopted under the circumstance.
METHODS We conducted a systematic review of the literature on PubMed by searching for studies published up to October 2022. The search was carried out using the exploded medical subject heading terms “lumen apposing metal stent”, “LAMS”, “endoscopic ultrasound” and “choledochoduodenostomy” or “gallbladder” or “pancreatic fluid collections”. We included in the review on-label EUS-guided procedures namely EUS-CDS, EUS-GBD and EUS-PFC. Only those publications reporting EUS-guided LAMS positioning were considered. The studies reporting a technical success rate of 100% and other procedure-related adverse events were considered to calculate the overall rate of LAMS misdeployment, while studies not reporting the causes of technical failure were excluded. Case reports were considered only for the extraction of data regarding the issues of misdeployment and rescue techniques. The following data were collected from each study: Author, year of publication, study design, study population, clinical indication, technical success, reported number of misdeployment, stent type and size, flange misdeployed and type of rescue strategy.
RESULTS The overall technical success rate of EUS-CDS, EUS-GBD and EUS-PFC was 93.7%, 96.1%, and 98.1% respectively. Significant rates of LAMS misdeployment have been reported for EUS-CDS, EUS-GBD and EUS-PFC drainage, respectively 5.8%, 3.4%, and 2.0%. Endoscopic rescue treatment was feasible in 86.8%, 80%, and 96.8% of cases. Non endoscopic rescue strategies were required only in 10.3%, 16% and 3.2% for EUS-CDS, EUS-GBD, and EUS-PFC. The endoscopic rescue techniques described were over-the-wire deployment of a new stent through the created fistula tract in 44.1%, 8% and 64.5% and stent-in-stent in 23.5%, 60%, and 12.9%, respectively for EUS-CDS, EUS-GBD, and EUS-PFC. Further therapeutic option were endoscopic rendezvous in 11.8% of EUS-CDS and repeated procedure of EUS-guided drainage in 16.1% of EUS-PFC.
CONCLUSION LAMS misdeployment is a relatively common adverse event in EUS-guided drainages. There is no consensus on the best rescue approach in these cases and the choice is often made by the endoscopist relying upon the clinical scenario, anatomical characteristics, and local expertise. In this review, we investigated the misdeployment of LAMS for each of the on-label indications focusing on the rescue therapies used, with the aim of providing useful data for endoscopists and to improve patient outcomes.
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Affiliation(s)
- Elia Armellini
- Department of Gastroenterology, ASST-Bergamoest, Seriate 24068, Bergamo, Italy
| | - Flavio Metelli
- Department of Gastroenterology, ASST-Bergamoest, Seriate 24068, Bergamo, Italy
| | - Andrea Anderloni
- Gastroenterology and Digestive Endoscopy Unit, Fondazione IRCCS Policlinico San Matteo, Pavia 27100, Italy
| | - Anna Cominardi
- Department of Gastroenterology, “Guglielmo da Saliceto” Hospital, Piacenza 29121, Italy
| | - Giovanni Aragona
- Department of Gastroenterology, “Guglielmo da Saliceto” Hospital, Piacenza 29121, Italy
| | - Michele Marini
- Department of General Surgery, ASST-Bergamoest, Seriate 24068, Italy
| | - Fabio Pace
- Department of Gastroenterology, ASST-Bergamoest, Seriate 24068, Bergamo, Italy
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Kawaguchi S, Matsuda M, Satoh T. Treatment of refractory cholangitis due to sphincter of Oddi dysfunction with endoscopic ultrasonography-guided biliary drainage. Dig Endosc 2023; 35:147. [PMID: 36250217 DOI: 10.1111/den.14456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 10/13/2022] [Indexed: 01/17/2023]
Affiliation(s)
- Shinya Kawaguchi
- Department of Gastroenterology, Shizuoka General Hospital, Shizuoka, Japan
| | - Masanori Matsuda
- Department of Gastroenterology, Shizuoka General Hospital, Shizuoka, Japan
| | - Tatsunori Satoh
- Department of Gastroenterology, Shizuoka General Hospital, Shizuoka, Japan
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Yi H, Liu Q, He S, Zhong L, Wu SH, Guo XD, Ning B. Current uses of electro-cautery lumen apposing metal stents in endoscopic ultrasound guided interventions. Front Med (Lausanne) 2022; 9:1002031. [PMID: 36530880 PMCID: PMC9747751 DOI: 10.3389/fmed.2022.1002031] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Accepted: 11/11/2022] [Indexed: 09/10/2023] Open
Abstract
The electro-cautery lumen apposing metal stent (EC-LAMS) is a newly developed device that integrates the electro-cautery cyctotome with the one-step metal stent delivery and releasing system in recent years. LAMS was first designed to complete the drainage of pancreatic fluid collection under endoscopic ultrasound guidance, and the technological innovation of EC-LAMS has made more off-labeled indications of endoscopic intervention for gastrointestinal diseases realized, such as abdominal fluid drainage, bile duct, or gallbladder drainage through stomach or duodenum, gastrointestinal anastomosis, and the establishment of fistulous channel for further endoscopic operation when necessary. The unique feature of this metal stent is that it has the design of a saddle shape and a large lumen, and can almost connect the adjacent structures to minimize the risk of perforation and leakage. Compared with traditional LAMS, EC-LAMS, an advanced integrated device, can greatly simplify the endoscopic process, shorten the procedure time and reduce the technical difficulty, thus it can help endoscopists complete more complex endoscopic interventions. In this review, we discuss the state of art with regard to EC-LAMS and its endoscopic process, current indications, outcomes, adverse events, and future application prospects.
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Affiliation(s)
- Hang Yi
- Department of Gastroenterology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qin Liu
- Department of Gastroenterology, Chongqing General Hospital, Chongqing, China
| | - Song He
- Department of Gastroenterology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Li Zhong
- Department of Gastroenterology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Su-hua Wu
- Department of Gastroenterology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xiao-dong Guo
- Department of Gastroenterology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Bo Ning
- Department of Gastroenterology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
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