Endoscopy 2019; 51(06): 540-547
DOI: 10.1055/a-0735-9137
Original article
© Georg Thieme Verlag KG Stuttgart · New York

Endoscopic ultrasound-guided choledochoduodenostomy with electrocautery-enhanced lumen-apposing stents: a retrospective analysis

Jeremie Jacques
1   Service d’Hépato-gastro-entérologie, CHU Dupuytren, Limoges, France
,
Jocelyn Privat
2   Service d’Hépato-gastro-entérologie, CH Jacques Lacarin, Vichy, France
,
Fabien Pinard
3   Service d’Hépato-gastro-entérologie, Hopital de Cournouaille, Quimper, France
,
Fabien Fumex
4   Service d’Hépato-gastro-entérologie, Hopital Privé Jean Mermoz, Lyon, Farnce
,
Jean-Christophe Valats
5   Service d’Hépato-gastro-entérologie, CHU Saint-Eloi, Montpellier, France
,
Azzedine Chaoui
6   Service d’Hépato-gastro-entérologie, CH Moulins, Moulins, France
,
Franck Cholet
7   Service d’Hépato-gastro-entérologie, CHU Brest, Brest, France
,
Bruno Godard
8   Service d’Hépato-gastro-entérologie, CHU Trousseau, Tours, France
,
Philippe Grandval
9   Service d’Hépato-gastro-entérologie, Hopital La Timone, Assistance Publique des Hopitaux de Marseille, Marseille, France
,
Romain Legros
1   Service d’Hépato-gastro-entérologie, CHU Dupuytren, Limoges, France
,
Sebastien Kerever
10   Service de Biostatistique et Information Médicale Hôpital Saint Louis APHP, Paris, France
,
Bertrand Napoleon
4   Service d’Hépato-gastro-entérologie, Hopital Privé Jean Mermoz, Lyon, Farnce
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Publikationsverlauf

submitted 22. Mai 2018

accepted after revision: 31. Juli 2018

Publikationsdatum:
22. Oktober 2018 (online)

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Abstract

Background Endoscopic ultrasound-guided biliary drainage is an alternative to percutaneous biliary drainage in cases of malignant biliary obstruction and failure of classic endoscopic drainage by endoscopic retrograde cholangiopancreatography (ERCP). Recently, a new electrocautery-enhanced lumen-apposing metal stent (ECE-LAMS) that allows for endoscopic anastomosis (apposition stent) has become available for use in EUS-choledochoduodenostomy (EUS-CDS) and facilitates the procedure.

Methods This was a retrospective study of all EUS-CDS procedures performed in France between April 2016 and August 2017. The primary end point was the technical and clinical success rates of EUS-CDS using an ECE-LAMS.

Results 52 consecutive patients were included in the study. The etiology of distal bile duct obstruction was distal pancreatic adenocarcinoma in 43 patients (82.7 %). The technical success rate was 88.5 % (46 /52 patients), and the clinical success rate was 100 % (46/46 patients). The mean duration of the procedure was 10.2 minutes (range 1 – 90). Two patients (3.8 %) presented with short-term complications after EUS-CDS and before discharge from hospital. In univariate analyses, a small diameter of the common bile duct and not following the recommended procedure technique were significant risk factors for technical failure. Over a mean follow-up of 157 days, the median survival time without biliary complications was 135 days.

Conclusion EUS-CDS with an ECE-LAMS is efficacious and safe in distal malignant obstruction of the common bile duct and could be proposed as the first option in cases of ERCP failure.