scholarly journals EUS-guided choledochoduodenostomy with a lumen-apposing metal stent for biliary drainage

VideoGIE ◽  
2017 ◽  
Vol 2 (9) ◽  
pp. 221-222
Author(s):  
William Hsueh ◽  
Sardar M. Shah-Khan ◽  
John Y. Nasr
Keyword(s):  
2014 ◽  
Vol 79 (5) ◽  
pp. AB408
Author(s):  
Tae Jun Song ◽  
Sang Soo Lee ◽  
Do Hyun Park ◽  
Dong Wan Seo ◽  
Sung Koo Lee ◽  
...  

Trials ◽  
2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Yen-I Chen ◽  
◽  
Kashi Callichurn ◽  
Avijit Chatterjee ◽  
Etienne Desilets ◽  
...  

Abstract Background & aims Endoscopic ultrasound guided-biliary drainage (EUS-BD) is a promising alternative to endoscopic retrograde cholangiopancreatography (ERCP); however, its growth has been limited by a lack of multicenter randomized controlled trials (RCT) and dedicated devices. A dedicated EUS-BD lumen- apposing metal stent (LAMS) has recently been developed with the potential to greatly facilitate the technique and safety of the procedure. We aim to compare a first intent approach with EUS-guided choledochoduodenostomy with a dedicated biliary LAMS vs. standard ERCP in the management of malignant distal biliary obstruction. Methods The ELEMENT trial is a multicenter single-blinded RCT involving 130 patients in nine Canadian centers. Patients with unresectable, locally advanced, or borderline resectable malignant distal biliary obstruction meeting the inclusion and exclusion criteria will be randomized to EUS-choledochoduodenostomy using a LAMS or ERCP with traditional metal stent insertion in a 1:1 proportion in blocks of four. Patients with hilar obstruction, resectable cancer, or benign disease are excluded. The primary endpoint is the rate of stent dysfunction needing re-intervention. Secondary outcomes include technical and clinical success, interruptions in chemotherapy, rate of surgical resection, time to stent dysfunction, and adverse events. Discussion The ELEMENT trial is designed to assess whether EUS-guided choledochoduodenostomy using a dedicated LAMS is superior to conventional ERCP as a first-line endoscopic drainage approach in malignant distal biliary obstruction, which is an important and timely question that has not been addressed using an RCT study design. Trial registration Registry name: ClinicalTrials.gov. Registration number: NCT03870386. Date of registration: 03/12/2019.


2014 ◽  
Vol 80 (4) ◽  
pp. 707-711 ◽  
Author(s):  
Tae Jun Song ◽  
Sang Soo Lee ◽  
Do Hyun Park ◽  
Dong Wan Seo ◽  
Sung Koo Lee ◽  
...  

Endoscopy ◽  
2018 ◽  
Vol 50 (07) ◽  
pp. E190-E191 ◽  
Author(s):  
Dario Ligresti ◽  
Michele Amata ◽  
Antonino Granata ◽  
Fabio Cipolletta ◽  
Luca Barresi ◽  
...  

2018 ◽  
Vol 02 (03) ◽  
pp. 135-143 ◽  
Author(s):  
Daniel Schmitz ◽  
Niels Weller ◽  
Matthias Doll ◽  
Simon Weingärtner ◽  
Nuria Pelaez ◽  
...  

Abstract Aims In recently published comparative studies, it is reported that percutaneous transhepatic biliary drainage (PTBD) is less successful, causes more adverse events, and needs more re-interventions than endoscopic ultrasound-guided biliary drainage (EUS-BD) in patients with malignant extrahepatic bile duct obstruction when endoscopic retrograde cholangiopancreatography (ERCP) fails. Could an improved technique of PTBD produce better results to use this technique for further comparative studies with EUSBD? Methods In our tertiary referral hospital, 116 prospectively documented, and retrospectively analyzed PTBDs with ultrasound guided ductal puncture were performed. In 16 of 30 PTBDs with metal stent implantation in malignant diseases, metal stent was inserted as a one-step procedure by endoscopic luminal guidance in the first session. Results Fifteen of 16 (94%) or 14/16 (88%) of PTBDs with primary metal stent implantation were technically or clinically successful. Mainly the left liver was used as access route for PTBD. Procedure time was 68.1 minutes (25–118), fluoroscopic time: 18.6 minutes (3–46), and patient radiation exposure: 5957 μGy/m2 (471–17,569). In 2/16 (12.5%) patients, adverse events (1 × mild and 1 × moderate grade of severity) were documented. One re-intervention was necessary (0.1/patient) in the observation time of 6 months. The mean overall survival time was 163.2 (7–864) days after PTBD. Conclusions PTBD with ultrasound-guided ductal puncture and primary metal implantation by endoscopic luminal guidance in patients with malignant extrahepatic bile duct obstruction showed good technical and clinical success and low adverse event and reintervention rates in our retrospective cohort study. Clinical Trial Registration: ClinicalTrials.gov ID: NCT03541590.


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