The summaries are free for public
use. The Chronic Liver Disease
Foundation will continue to add and
archive summaries of articles deemed
relevant to CLDF by the Board of
Trustees and its Advisors.
Abstract Details
Utility of palliative EUS-guided biliary drainage using lumen-apposing metal stents: a prospective multicenter feasibility study (with video)
Gastrointest Endosc. 2021 Feb 2;S0016-5107(21)00090-0. doi: 10.1016/j.gie.2021.01.029.Online ahead of print.
Suresh Vasan Venkatachalapathy1, Martin W James1, Matthew Huggett2, Bharat Paranandi2, Stephen P Pereira3, Gavin Johnson4, Aloysious D Aravinthan5, Guruprasad P Aithal5
Author information
1NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, United Kingdom.
3University College London - UCL Institute for Liver & Digestive Health, London; University College Hospitals NHS Foundation Trust - Department of Gastroenterology, London, United Kingdom.
4University College Hospitals NHS Foundation Trust - Department of Gastroenterology, London, United Kingdom.
5NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, United Kingdom; Nottingham Digestive Diseases Centre, School of Medicine, University of Nottingham, Nottingham, United Kingdom.
Abstract
Background and aims: Biliary drainage with ERCP is successful in only 80% to 90% of extrahepatic cholangiocarcinoma and pancreatic cancer. We present the results of a multicenter prospective study assessing the safety, feasibility, and quality of life of patients after EUS-guided biliary drainage (EUS-BD) with lumen-apposing metal stents (LAMSs), after failed ERCP.
Methods: All consecutive adults with a dilated common bile duct (CBD) ≥14 mm secondary to inoperable malignant distal common bile duct (CBD) stricture and failed ERCP biliary drainage were screened and recruited from 3 tertiary U.K. centers. Technical success of EUS-BD using LAMSs was the primary endpoint. Improvement in serum bilirubin, 30-day mortality, procedure-related adverse events, and quality of life were secondary endpoints. The quality of life improvement was measured using a validated questionnaire (EORTC QLQ-BIL21).
Results: Twenty patients were included in analysis. EUS-BD was technically successful in all patients and the clinical success was 95% (19/20) at day 7 (>50% reduction in bilirubin) and 92.3% (12/13) at day 30 (bilirubin <50 μmol/L). There were significant improvements in overall quality of life score (49 vs 42, p=0.03) at day 30. All cause 30-day mortality was 20% and the moderate adverse event rate was 10% (1 cholangitis and 1 stent migration).
Conclusion: EUS-BD has acceptable technical success and safety as a second line palliative treatment for inoperable malignant distal CBD strictures. Randomized controlled studies comparing EUS-BD with percutaneous transhepatic biliary drainage (PTBD) are needed to determine their effectiveness in clinical practice.