Is a coaxial plastic stent within a lumen-apposing metal stent useful for the management of distal malignant biliary obstruction?
Por:
Garcia-Sumalla, A, Loras, C, Guarner-Argente, C, Velasquez-Rodriguez, JG, Andujar, X, Salord, S, Busquets, J, Tebe, C, Laquente, B, Gornals, JB
Publicada:
1 ago 2021
Ahead of Print:
1 mar 2021
Resumen:
Background There are uncertainties concerning the possible benefits derived from the insertion of double-pigtail plastic stents (DPS) within lumen-apposing metal stents (LAMS) in EUS-guided choledochoduodenostomy (CDS). The aim of this study was to determine whether a DPS within a biliary LAMS offers a potential benefit in EUS-guided CDS for the palliative management of malignant biliary obstruction.
Methods This was a multicentre retrospective study at three tertiary institutions. Period: May 2015 to August 2020. Two interventional strategies (LAMS alone and LAMS plus DPS) were compared. The choice was the endoscopist's discretion. Inclusion: unresectable/inoperable biliopancreatic tumours with previous failed ERCP. Clinical success: bilirubin decrease > 30% at 4 weeks.
Results Forty-one consecutive cases of EUS-CDS using biliary LAMS were treated (22 women; mean age, 72.3 years) during the study period. The procedure was technically successful in 39 (95.1%), who were managed using the two strategies (22 LAMS alone; 17 LAMS plus DPS). No differences between the groups, in terms of clinical success (77.3 vs 87.5%, p = 0.67), adverse events (AEs, 13.6 vs 11.8%, p = 0.99), recurrent biliary obstruction (RBO, 13.6 vs 23.5%, p = 0.67), or survival rate (p = 0.67) were encountered. The LAMS alone group had a shorter length of procedure (50 min vs 66 min, p = 0.102). No risk factors related to clinical success, AEs, RBO, or survival were detected.
Conclusions The technical variant of adding a coaxial DPS within LAMS in EUS-CDS seems not to be enough to prevent biliary morbidities, and it is a time-consuming strategy. Although prospective studies are needed, these results do not support its routine use.
Filiaciones:
Garcia-Sumalla, A:
Univ Barcelona, Bellvitge Biomed Res Inst IDIBELL, Hosp Univ Bellvitge, Endoscopy Unit,Dept Digest Dis, Barcelona, Catalonia, Spain
Loras, C:
Hosp Univ Mutua Terrassa, Fundacio Recerca Mutua Terrassa, CIBERehd, Endoscopy Unit,Dept Digest Dis, Terrassa, Spain
Univ Oberta Catalunya, Fac Hlth Sci, Barcelona, Catalonia, Spain
Guarner-Argente, C:
Hosp St Pau & Santa Creu, Dept Digest Dis, Endoscopy Unit, Barcelona, Catalonia, Spain
Univ Oberta Catalunya, Fac Hlth Sci, Barcelona, Catalonia, Spain
Velasquez-Rodriguez, JG:
Univ Barcelona, Bellvitge Biomed Res Inst IDIBELL, Hosp Univ Bellvitge, Endoscopy Unit,Dept Digest Dis, Barcelona, Catalonia, Spain
Andujar, X:
Hosp Univ Mutua Terrassa, Fundacio Recerca Mutua Terrassa, CIBERehd, Endoscopy Unit,Dept Digest Dis, Terrassa, Spain
Salord, S:
Univ Barcelona, Bellvitge Biomed Res Inst IDIBELL, Hosp Univ Bellvitge, Endoscopy Unit,Dept Digest Dis, Barcelona, Catalonia, Spain
Busquets, J:
Univ Barcelona, Bellvitge Biomed Res Inst IDIBELL, Hosp Univ Bellvitge, Dept Surg, Barcelona, Catalonia, Spain
Tebe, C:
Bellvitge Biomed Res Inst IDIBELL, Biostat Unit, Barcelona, Spain
Laquente, B:
Bellvitge Biomed Res Inst IDIBELL, Inst Catala Oncol DiR, Dept Med Oncol, Barcelona, Spain
Gornals, JB:
Univ Barcelona, Bellvitge Biomed Res Inst IDIBELL, Hosp Univ Bellvitge, Endoscopy Unit,Dept Digest Dis, Barcelona, Catalonia, Spain
Univ Oberta Catalunya, Fac Hlth Sci, Barcelona, Catalonia, Spain
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