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Lumen apposing metal stents versus tubular self-expandable metal stents for endoscopic ultrasound-guided choledochoduodenostomy in malignant biliary obstruction

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Abstract

Background and aims

EUS-guided choledochoduodenostomy (EUS-CDS) is an effective option for biliary drainage in malignant biliary obstruction. Lumen apposing metal stents (LAMS) are increasingly been used for EUS-CDS. It is unknown how LAMS compare to tubular self-expandable metal stents (SEMS) for EUS-CDS. Our aim is to compare the clinical outcomes of LAMS versus SEMS for EUS-CDS.

Patients and methods

Single-center retrospective cohort study of consecutive patients with unresectable malignant biliary obstruction who underwent EUS-CDS after failed ERCP for initial biliary drainage between 2011 and 2019. Clinical outcomes were compared between patients who had conventional covered SEMS and LAMS placed for EUS-CDS. Outcome measures included unplanned procedural events, technical success, clinical success, adverse events and reinterventions. Survival was analyzed by the Kaplan–Meier method.

Results

During the study period 57 patients met inclusion criteria (37 LAMS, 20 SEMS). All EUS-CDS were technically successful (LAMS group 95% CI 90.3–100%, SEMS group 95% CI 83.2–100%). There were no differences between groups in unplanned procedural events (4 LAMS deployment issues, 2 mild bleeding in SEMS group; 10 vs 10.8%), clinical success (37/37 [100%] vs 19/20 [95%]), and short-term adverse events (5/37 [13.5%] vs 4/20 [20%], p = 0.71). Complete follow-up data were available in 41 patients for a mean of 376 ± 145 days. Endoscopic reintervention was required for duodenal stent placement (n = 9) or biliary stent dysfunction (n = 4), with no difference between LAMS and SEMS group (6/37 [16.2%] vs 7/20 [35%]). There were no differences in overall survival between both groups.

Conclusions

EUS-guided choledochoduodenostomy after failed ERCP has equally high technical and clinical success rates with either LAMS or SEMS in patients with malignant biliary obstruction. No differences in adverse events, reinterventions and survival were seen with either type of stent. The cost-effectiveness of LAMS vs SEMS for EUS-guided choledochoduodenostomy remains to be proven.

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Funding

No financial support was needed to conduct this study.

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Authors and Affiliations

  1. Gastroenterology Department, Hospital Universitario Río Hortega, Calle Dulzaina 2, 47012, Valladolid, Spain

    Marina de Benito Sanz, Rodrigo Nájera-Muñoz, Carlos de la Serna-Higuera, Esteban Fuentes-Valenzuela, Ignacio Fanjul, Carlos Chavarría, Francisco Javier García-Alonso, Ramón Sanchez-Ocana, Ana Yaiza Carbajo, Sergio Bazaga & Manuel Perez-Miranda

Authors
  1. Marina de Benito Sanz
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  2. Rodrigo Nájera-Muñoz
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  3. Carlos de la Serna-Higuera
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  4. Esteban Fuentes-Valenzuela
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  9. Ana Yaiza Carbajo
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  11. Manuel Perez-Miranda
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Corresponding author

Correspondence to Marina de Benito Sanz.

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Disclosures

Dr. Manuel Perez-Miranda is a consultant for Boston Scientific and M.I.Tech and has lectured for Boston Scientific and Olympus. Dra. Marina de Benito Sanz, Dr. Rodrigo Nájera Muñoz, Dr. Carlos de la Serna, Dr. Esteban Fuentes-Valenzuela, Dr. Ignacio Fanjul, Dr. Carlos Chavarría, Dr. Francisco Javier Garcia-Alonso, Dr. Ramón Sanchez-Ocana, Dra. Ana Yaiza Carbajo and Dr. Sergio Bazaga have no potential conflicts of interest.

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de Benito Sanz, M., Nájera-Muñoz, R., de la Serna-Higuera, C. et al. Lumen apposing metal stents versus tubular self-expandable metal stents for endoscopic ultrasound-guided choledochoduodenostomy in malignant biliary obstruction. Surg Endosc 35, 6754–6762 (2021). https://doi.org/10.1007/s00464-020-08179-y

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