EUS-GUIDED CHOLEDOCHODUODENOSTOMY USING A LUMEN APPOSING METAL STENT FOR MALIGNANT DISTAL BILIARY OBSTRUCTION: A RESTROSPECTIVE ANALYSIS OF A SINGLE CENTER EXPERIENCE

Aims:

Endoscopic ultrasonography guided choledochoduodenostomy (EUS-CD) using a lumen apposing stent has been recently reported as an alternative approach in patients with malignant obstructive jaundice and failed ERCP.

The aim of this study was to evaluate the safety, technical and clinical efficacy of this procedure.

Methods:

Retrospective analysis of a prospectively maintained registry of consecutive patients with unresectable malignant distal bile duct obstruction who, (October 2015 – October 2017), underwent EUS-CD using the study device (Hot-AXIOS, Boston Scientific Corp., Massachusetts, USA) after unsuccessful ERCP.

Results:

Thirty-five patients (19 M/16F; median age 71.3 ± 12.4) underwent direct EUS-CD using the Hot AXIOS (6 mm in 16 (45.7%); 8 mm in 13 (37.2%); 10 mm in 6 (17.1%). ERCP failure was due to inability to get deep biliary cannulation in 24 patients (68.6%) and to duodenal obstruction in the remaining 11 patients (31.4%).

The procedure was technically successful in 33/35 patients (94.3%) (mean procedural time 37.9 min (range 10 – 104)). Stent placement failed in 2 cases (5.7%). Clinical success was achieved in 31/33 patients (93.9%) with a reduction in the total bilirubin level of 63.42% within 7 days of the initial levels. The median post-procedure hospitalization was 5.64 ± 6.73 days. The mean FU was 105 days (range 17 – 411). During FU 11 patients died because of disease progression. Major complications occurred in 5 patients (16.1%) after a mean of 69.5 days (range 17 – 148 d): 1 fatal bleeding 17 days after stent placement; 3 stent occlusion due to food impact, 1 spontaneous migration requiring re-intervention.

Conclusions:

This study shows that EUS-CD using the Hot AXIOS is associated with high technical and clinical success rates. The rate of complications including one fatal event is not negligible and should be carefully considered before using the stent in this clinical setting. Future prospective comparative studies are required to fully assess the long-term efficacy and safety of the stent.

 

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