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CC BY-NC-ND 4.0 · Endosc Int Open 2021; 09(03): E324-E330
DOI: 10.1055/a-1333-1053
Original article

Lumen-apposing metal stent through the meshes of duodenal metal stents for palliation of malignant jaundice

Benedetto Mangiavillano
1   Gastrointestinal Endoscopy Unit – Humanitas Mater Domini – Castellanza (VA), Italy
2   Humanitas University, Pieve Emanuele (MI), Italy
,
Rastislav Kunda
3   Department of Surgery, Department of Gastroenterology and Hepatology, and Department of Advanced Interventional Endoscopy, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
4   Department of Surgical Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
,
Carlos Robles-Medranda
5   Instituto Ecuatoriano de Enfermedades Digestivas (IECED), Guayaquil, Ecuador
,
Roberto Oleas
5   Instituto Ecuatoriano de Enfermedades Digestivas (IECED), Guayaquil, Ecuador
,
Andrea Anderloni
6   Endoscopy Unit, Istituto Clinico Humanitas Research Hospital, Milan
,
Adrien Sportes
7   Digestive Endoscopy, Institut Arnault TZANCK Gastroenterology Unit, Saint-Laurent-du-Var, France
,
Carlo Fabbri
8   Digestive Endoscopy Unit, Endoscopy Unit, Morgagni-Pietrantoni Hospital, Forlì, Italy
,
Cecilia Binda
8   Digestive Endoscopy Unit, Endoscopy Unit, Morgagni-Pietrantoni Hospital, Forlì, Italy
,
Francesco Auriemma
1   Gastrointestinal Endoscopy Unit – Humanitas Mater Domini – Castellanza (VA), Italy
,
Leonardo H. Eusebi
9   Endoscopy Unit, Department of Medical and Surgical Sciences, Sant’Orsola University Hospital, Bologna, Italy
,
Leonardo Frazzoni
9   Endoscopy Unit, Department of Medical and Surgical Sciences, Sant’Orsola University Hospital, Bologna, Italy
,
Lorenzo Fuccio
9   Endoscopy Unit, Department of Medical and Surgical Sciences, Sant’Orsola University Hospital, Bologna, Italy
,
Matteo Colombo
6   Endoscopy Unit, Istituto Clinico Humanitas Research Hospital, Milan
,
Alessandro Fugazza
6   Endoscopy Unit, Istituto Clinico Humanitas Research Hospital, Milan
,
Mario Bianchetti
1   Gastrointestinal Endoscopy Unit – Humanitas Mater Domini – Castellanza (VA), Italy
,
Alessandro Repici
2   Humanitas University, Pieve Emanuele (MI), Italy
6   Endoscopy Unit, Istituto Clinico Humanitas Research Hospital, Milan
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Abstract

Background and study aims Endoscopic retrograde cholangiopancreatography (ERCP) is the gold standard procedure for malignant jaundice palliation; however, it can be challenging when a duodenal self-expandable metal stent (SEMS) is already in place.

Patients and methods The primary aim of our study was to evaluate the technical feasibility of the placement of a lumen apposing metal stent (LAMS) through the mesh (TTM) of duodenal stents. The secondary aims were to evaluate clinical outcomes and adverse events (AEs) related to the procedures.

Results Data from 23 patients (11 F and 12 M; mean age: 69.5 ± 11 years old) were collected. In 17 patients (73.9 %) TTM LAMS placement was performed as first intention, while in six patients (26.1 %) it was performed after a failed ERCP. Thirteen patients (56.5 %) underwent the procedure due to advanced pancreatic head neoplasia. One technical failure was experienced (4.3 %). The TTM LAMS placement led to a significant decrease in the serum levels of bilirubin, ALP, GGT, WBC and CRP. No cases of duodenal SEMS occlusion occurred and no other AEs were observed during the follow-up.

Conclusions Concomitant malignant duodenal and biliary obstruction is a challenging condition. Palliation of jaundice using TTM LAMS in patients already treated with duodenal stent is associated to promising technical and clinical outcomes.



Publication History

Article published online:
18 February 2021

© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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