EUS-Guided Biliary Drainage With Electrocautery-Enhanced Lumen-Apposing Metal Stent Placement Should Replace Ptbd After ERCP Failure In Patients With Distal Tumoral Biliary Obstruction: Retrospective Study

Aims In the context of malignant distal biliary obstruction, ERCP is the reference technique for bile duct drainage. In case of failure, the alternative techniques are percutaneous transhepatic biliary drainage and more recently endoscopic ultrasound-guided biliary drainage. A new type of stent called the electrocautery-enhanced lumen-apposing metal stent has been developed to enable the performance of biliodigestive anastomosis under EUS-guidance in a single step, without prior bile duct puncture or the need for a guidewire. The aim of our study was to compare the real-life efficacies of PTBD and EUS-BD with the EC-LAMS for cases of ERCP failure in patients with malignant biliary obstruction.

Methods We performed a monocentric retrospective study comparing PTBD and EUS-BD with the use of electrocautery-enhanced lumen apposing metal stent in the context of a malignant distal biliary obstruction after ERCP failure.

Results 95 patients were included (50 in the EUS-BD group and 45 in the PTBD group). The main etiology of malignant obstruction was adenocarcinoma of the head of the pancreas (85 %). There was a significant difference in favor of endoscopic ultrasound-guided biliary drainage using electrocautery-enhanced lumen apposing metal stent for the following criteria:clinical success (decrease of bilirubin level allowing chemotherapy): 89.3 % vs 45.5 %; p < 0.0001; technical success: 97.9 % vs 68.2 %; p = 0.00013, procedure-related adverse event rate: 2.12 % vs 22.7 %; p =  0.003; length of stay after drainage: 3.5 vs 8.2 days; p < 0.0001, overall cost of the strategy per patient: 5098 vs 9363 euros; p < 0.001.

Conclusions Our results are in favor of EUS-BD using electrocautery-enhanced lumen apposing metal stent in case of ERCP failure for a distal tumor biliary obstacle. Operators performing ERCP for distal tumor biliary obstacle must learn this backup procedure because of its superiority over percutaneous transhepatic biliary drainage in terms of technical success, clinical success, safety, cost.

Citation Ginestet C, Geyl S, Legros R et al. eP423 EUS-GUIDED BILIARY DRAINAGE WITH ELECTROCAUTERY-ENHANCED LUMEN-APPOSING METAL STENT PLACEMENT SHOULD REPLACE PTBD AFTER ERCP FAILURE IN PATIENTS WITH DISTAL TUMORAL BILIARY OBSTRUCTION: RETROSPECTIVE STUDY. Endoscopy 2021; 53: S234.

Publication History

Article published online:
19 March 2021