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Is a coaxial plastic stent within a lumen-apposing metal stent useful for the management of distal malignant biliary obstruction?

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Abstract

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.

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Authors and Affiliations

  1. Endoscopy Unit, Department of Digestive Diseases, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), University of Barcelona, Barcelona, Catalonia, Spain

    Albert Garcia-Sumalla, Julio G. Velasquez-Rodriguez, Silvia Salord & Joan B. Gornals

  2. Endoscopy Unit, Department of Digestive Diseases, Hospital Universitari Mútua Terrassa, Fundació per la Recerca Mútua Terrassa, CIBERehd, Terrassa, Spain

    Carme Loras & Xavier Andujar

  3. Endoscopy Unit, Department of Digestive Diseases, Hospital Sant Pau i Santa Creu, Barcelona, Catalonia, Spain

    Carlos Guarner-Argente

  4. Department of Surgery, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), University of Barcelona, Barcelona, Catalonia, Spain

    Juli Busquets

  5. Biostatistics Unit, Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain

    Cristian Tebe

  6. Department of Medical Oncology, Institut Català d’Oncologia DiR, Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet, Barcelona, Spain

    Berta Laquente

  7. Faculty of Health Sciences, Universitat Oberta de Catalunya, Barcelona, Catalonia, Spain

    Carme Loras, Carlos Guarner-Argente & Joan B. Gornals

Authors
  1. Albert Garcia-Sumalla
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  2. Carme Loras
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  6. Silvia Salord
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  10. Joan B. Gornals
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Contributions

AS acquisition of data, analysis and interpretation of data, drafting of the article, critical revision of the article, and final approval. CL, CA, JV and XA acquisition of data, analysis and interpretation of data, drafting of the article, critical revision of the article, and final approval. JB, SS and BL analysis and interpretation of data, critical revision of the article, and final approval. CT statistical analysis, analysis and interpretation of data, critical revision of the article, and final approval. JBG study concept and design, acquisition of data, statistical analysis, analysis and interpretation of data, drafting of the article, critical revision of the article for important intellectual content, and final approval.

Corresponding author

Correspondence to Joan B. Gornals.

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Disclosures

Dr. Albert Garcia-Sumalla is a PhD student (Universitat de Barcelona), and this paper is part of his doctoral project. Dr. Joan B Gornals acts as his PhD supervisor, and is also a consultant for Boston Scientific. Drs. Carme Loras, Carlos Guarner-Argente, Julio G Velasquez-Rodriguez, Xavi Andujar, Silvia Salord, Juli Busquets, Cristian Tebe and Berta Laquente have no conflicts of interest or financial ties to disclose.

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Supplementary Information

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Supplementary file1 (MP4 202529 kb). Video 1: EUS-guided cholecochoduodenostomy by using an electrocautery-enhanced lumen-apposing stent with coaxial double-pigtail plastic stent

Supplementary file2 (MP4 218462 kb). Video 2: EUS-guided cholecochoduodenostomy (LAMS plus DPS) as a rescue technique after a nonfunctional percutaneous transhepatic biliary drainage

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Garcia-Sumalla, A., Loras, C., Guarner-Argente, C. et al. Is a coaxial plastic stent within a lumen-apposing metal stent useful for the management of distal malignant biliary obstruction?. Surg Endosc 35, 4873–4881 (2021). https://doi.org/10.1007/s00464-021-08435-9

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  • DOI: https://doi.org/10.1007/s00464-021-08435-9

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