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Risk factors for stent dysfunction during long-term follow-up after EUS-guided biliary drainage using lumen-apposing metal stents: A prospective study.
Geyl, Sophie; Redelsperger, Benjamin; Yzet, Clara; Napoleon, Bertrand; Legros, Romain; Dahan, Martin; Lepetit, Hugo; Ginestet, Claire; Jacques, Jérémie; Albouys, Jérémie.
Afiliación
  • Geyl S; Department of Gastroenterology, Limoges University Hospital, Limoges, France.
  • Redelsperger B; Department of Gastroenterology, Limoges University Hospital, Limoges, France.
  • Yzet C; Department of Gastroenterology, Amiens University Hospital, Amiens, France.
  • Napoleon B; Department of Gastroenterology, Private Hospital Jean-Mermoz, Lyon, France.
  • Legros R; Department of Gastroenterology, Limoges University Hospital, Limoges, France.
  • Dahan M; Department of Gastroenterology, Limoges University Hospital, Limoges, France.
  • Lepetit H; Department of Gastroenterology, Limoges University Hospital, Limoges, France.
  • Ginestet C; Department of Gastroenterology, Limoges University Hospital, Limoges, France.
  • Jacques J; Department of Gastroenterology, Limoges University Hospital, Limoges, France.
  • Albouys J; Department of Gastroenterology, Limoges University Hospital, Limoges, France.
Endosc Ultrasound ; 12(2): 237-244, 2023.
Article en En | MEDLINE | ID: mdl-36891940
ABSTRACT

Background:

EUS-guided choledoco-duodenostomy using electrocautery-enhanced lumen-apposing metal stents (ECE-LAMS) is becoming the gold standard in case of endoscopic retrograde cholangio-pancreatography failure for distal malignant obstruction. Long-term data in larger samples are lacking.

Methods:

This was a prospective monocentric study including all patients who underwent EUS-guided choledochoduodenostomy (CDS) between September 2016 and December 2021. The primary endpoint was the rate of biliary obstruction during follow-up. Secondary endpoints were technical and clinical success rates, adverse event rates, and identification of risk factors for biliary obstruction.

Results:

One hundred and twenty-three EUS-guided CDS using ECE-LAMS were performed at Limoges University Hospital were performed during the study period and included in the study. The main cause of obstruction was pancreatic adenocarcinoma in 91 (74.5%) cases. The technical and clinical success rates were 97.5% and 91%, respectively. Twenty patients (16.3%) suffered from biliary obstructions during a mean follow-up of 242 days. The clinical success rate for endoscopic desobstruction was 80% (16/20). In uni- and multivariate analyses, only the presence of a duodenal stent (odds ratio [OR] 3.6, 95% confidence interval [CI] 95% 1.2-10.2; P = 0.018) and a bile duct thinner than 15 mm (OR 3.9, CI 95% 1.3-11.7; P = 0.015) were the significant risk factors for biliary obstruction during the follow-up.

Conclusion:

Obstruction of LAMS occurred in 16.3% of cases during follow-up and endoscopic desobstruction is efficacious in 80% of cases. The presence of duodenal stent and a bile duct thinner than 15 mm are the risk factors of obstruction. Except in these situation, EUS-CDS with ECE-LAMS could be proposed in the first intent in case of distal malignant obstruction.
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Texto completo: 1 Colección: 01-internacional Banco de datos: MEDLINE Tipo de estudio: Etiology_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Idioma: En Revista: Endosc Ultrasound Año: 2023 Tipo del documento: Article País de afiliación: Francia

Texto completo: 1 Colección: 01-internacional Banco de datos: MEDLINE Tipo de estudio: Etiology_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Idioma: En Revista: Endosc Ultrasound Año: 2023 Tipo del documento: Article País de afiliación: Francia