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Nimri F, Ichkhanian Y, Shinn B, Kowalski TE, Loren DE, Kumar A, Schlachterman A, Tantau A, Arevalo M, Taha A, Shamaa O, Viales MC, Khashab MA, Simmer S, Singla S, Piraka C, Zuchelli TE. Comprehensive analysis of adverse events associated with transmural use of LAMS in patients with liver cirrhosis: International multicenter study. Endosc Int Open 2024; 12:E740-E749. [PMID: 38847015 PMCID: PMC11156515 DOI: 10.1055/a-2312-1528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 04/16/2024] [Indexed: 06/09/2024] Open
Abstract
Background and study aims Endoscopic ultrasound (EUS)-guided transmural (TM) deployment of lumen-apposing metal stents (LAMS) is considered relatively safe in non-cirrhotic patients and is cautiously offered to cirrhotic patients. Patients and methods This was a retrospective, multicenter, international matched case-control study to study the safety of EUS-guided TM deployment of LAMS in cirrhotic patients. Results Forty-three cirrhotic patients with model for end-stage liver disease score 12.5 ± 5, with 23 having ascites and 16 with varices underwent EUS-guided TM LAMS deployment, including 19 for pancreatic fluid collection (PFC) drainage, 13 gallbladder drainage, six for endoscopic ultrasound-directed transgastric endoscopic retrograde cholangiopancreatography (ERCP), three for EDGI, one for endoscopic ultrasound-directed transenteric ERCP, and one postsurgical collection drainage. Technical failure occurred in one LAMS for PFC drainage. Clinical failure was encountered in another PFC. Nine adverse events (AEs) occurred. The most common AE was LAMS migration (3), followed by non-bleeding mucosal erosion (2), delayed bleeding (2), sepsis (1), and anesthesia-related complication (pulseless electrical activity) (1). Most AEs were graded as mild (6), followed by severe (2), and moderate (1); the majority were managed conservatively. On univariable comparison, risk of AE was higher when using a 20 × 10 mm LAMS and the absence of through-the-LAMS plastic stent(s). Conditional logistic regression of matched case-control patients did not show any association between potential predicting factors and occurrence of AEs. Conclusions Our study demonstrated that mainly in patients with Child-Pugh scores A and B cirrhosis and despite the presence of mild-to-moderate ascites in over half of cases, the majority of AEs were mild and could be managed conservatively. Further studies are warranted to verify the safety of LAMS in cirrhotic patients.
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Affiliation(s)
- Faisal Nimri
- Division of Gastroenterology and Hepatology, Henry Ford Hospital, Detroit, United States
| | - Yervant Ichkhanian
- Department of Internal Medicine, Henry Ford Hospital, Detroit, United States
| | - Brianna Shinn
- Division of Gastroenterology and Hepatology, Thomas Jefferson Hospital, Wayne, United States
| | - Thomas E. Kowalski
- Division of Gastroenterology and Hepatology, Thomas Jefferson Hospital, Wayne, United States
| | - David E. Loren
- Division of Gastroenterology and Hepatology, Thomas Jefferson Hospital, Wayne, United States
| | - Anand Kumar
- Division of Gastroenterology and Hepatology, Thomas Jefferson Hospital, Wayne, United States
| | - Alexander Schlachterman
- Division of Gastroenterology and Hepatology, Thomas Jefferson Hospital, Wayne, United States
| | - Alina Tantau
- Division of Gastroenterology and Hepatology Medical Center, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Martha Arevalo
- Instituto Ecuatoriano de Enfermedades Digestivas (IECED), Guayaquil, Ecuador
| | - Ashraf Taha
- Division of Gastroenterology and Hepatology, Henry Ford Hospital, Detroit, United States
| | - Omar Shamaa
- Department of Internal Medicine, Henry Ford Hospital, Detroit, United States
| | | | - Mouen A. Khashab
- Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, United States
| | - Stephen Simmer
- Division of Gastroenterology and Hepatology, Henry Ford Hospital, Detroit, United States
| | - Sumit Singla
- Division of Gastroenterology and Hepatology, Henry Ford Hospital, Detroit, United States
| | - Cyrus Piraka
- Division of Gastroenterology and Hepatology, Henry Ford Hospital, Detroit, United States
| | - Tobias E. Zuchelli
- Division of Gastroenterology and Hepatology, Henry Ford Hospital, Detroit, United States
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Vila JJ, Jusué Irurita V, Rullán Iriarte M. Is ERCP still the elective primary biliary drainage technique in patients with malignant distal biliary obstruction? REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2024; 116:182-185. [PMID: 38095214 DOI: 10.17235/reed.2023.10029/2023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/17/2024]
Abstract
Endoscopic retrograde cholangiopancreatography (ERCP) has been established as the first line therapy for the resolution of biliary and pancreatic diseases. The main disadvantage of the procedure is the rate of adverse events, around 10%1. So, despite being a minimally invasive procedure, ERCP has a non-negligible rate of adverse effects (AEs) and secondary mortality.
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Affiliation(s)
- Juan J Vila
- Endoscopy Unit. Gastroenterology Department, Hospital Universitario de Navarra, España
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Chin NH, Chung CS, Chen KC, Wu JM. Endoscopic ultrasound-guided lumen-apposing metal stent for large gallstone removal in a symptomatic but surgically unfit patient. Asian J Surg 2023; 46:946-948. [PMID: 35973894 DOI: 10.1016/j.asjsur.2022.07.071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 07/15/2022] [Indexed: 02/08/2023] Open
Affiliation(s)
- Ning-Hsuan Chin
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Chen-Shuan Chung
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan; College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan; Taiwan Association for the Study of Small Intestinal Diseases (TASSID), Taiwan
| | - Kuan-Chih Chen
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Jiann-Ming Wu
- Department of Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan.
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Paduano D, Facciorusso A, De Marco A, Ofosu A, Auriemma F, Calabrese F, Tarantino I, Franchellucci G, Lisotti A, Fusaroli P, Repici A, Mangiavillano B. Endoscopic Ultrasound Guided Biliary Drainage in Malignant Distal Biliary Obstruction. Cancers (Basel) 2023; 15:cancers15020490. [PMID: 36672438 PMCID: PMC9856645 DOI: 10.3390/cancers15020490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Revised: 01/08/2023] [Accepted: 01/09/2023] [Indexed: 01/15/2023] Open
Abstract
Malignant biliary obstruction (MBO) is a challenging medical problem that often negatively impacts the patient's quality of life (QoL), postoperative complications, and survival rates. Endoscopic approaches to biliary drainage are generally performed by ERCP or, in selected cases, with a percutaneous transhepatic biliary drainage (PTBD). Recent advances in therapeutic endoscopic ultrasound (EUS) allow drainage where previous methods have failed. EUS has evolved from a purely diagnostic technique to one that allows a therapeutic approach in the event of ERCP failure in distal MBO. Moreover, the introduction of dedicated accessories and prostheses for EUS-guided transmural biliary drainage (EUS-BD) made these procedures more successful with regard to technical success, clinical outcomes and reduction of adverse events (AEs). Finally, lumen-apposing metal stents (LAMS) have improved the therapeutic role of the EUS. Subsequently, the electrocautery enhanced tip of the LAMS (EC-LAMS) allows a direct access of the delivery system to the target lumen, thereby simplifying and reducing the EUS-BD procedure time. EUS-BD using LAMS and EC-LAMS has proven effective and safe with a low rate of AEs. This review aims to evaluate biliary drainage techniques in malignant obstruction, focusing on the role of EUS biliary drainage by LAMS.
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Affiliation(s)
- Danilo Paduano
- Gastrointestinal Endoscopy Unit, Humanitas Mater Domini, 21053 Castellanza, Italy
- Correspondence: (D.P.); (B.M.); Tel.: +39-0331-476205 (D.P.)
| | - Antonio Facciorusso
- Gastroenterology Unit, Department of Surgical and Medical Sciences, University of Foggia, 71122 Foggia, Italy
- Gastroenterology and Digestive Endoscopy Unit, Department of Medicine, The Pancreas Institute, University Hospital of Verona, 37100 Verona, Italy
| | - Alessandro De Marco
- Endoscopy Unit, Humanitas Clinical and Research Center IRCCS, 20089 Rozzano, Italy
| | - Andrew Ofosu
- Division of Gastroenterology and Hepatology, University of Cincinnati, Cincinnati, OH 45201, USA
| | - Francesco Auriemma
- Gastrointestinal Endoscopy Unit, Humanitas Mater Domini, 21053 Castellanza, Italy
| | - Federica Calabrese
- Gastrointestinal Endoscopy Unit, Humanitas Mater Domini, 21053 Castellanza, Italy
| | - Ilaria Tarantino
- Endoscopy Service, Department of Diagnostic and Therapeutic Services, IRCCS-ISMETT, 90100 Palermo, Italy
| | | | - Andrea Lisotti
- Gastroenterology Unit, Hospital of Imola, University of Bologna, 40121 Bologna, Italy
| | - Pietro Fusaroli
- Gastroenterology Unit, Hospital of Imola, University of Bologna, 40121 Bologna, Italy
| | - Alessandro Repici
- Endoscopy Unit, Humanitas Clinical and Research Center IRCCS, 20089 Rozzano, Italy
- Department of Biomedical Sciences, Humanitas University, 20089 Rozzano, Italy
| | - Benedetto Mangiavillano
- Gastrointestinal Endoscopy Unit, Humanitas Mater Domini, 21053 Castellanza, Italy
- Department of Biomedical Sciences, Humanitas University, 20089 Rozzano, Italy
- Correspondence: (D.P.); (B.M.); Tel.: +39-0331-476205 (D.P.)
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Endoscopic Ultrasound-Guided Gastrojejunostomy for Superior Mesenteric Artery Syndrome Secondary to Rapid Weight Loss. ACG Case Rep J 2022; 9:e00868. [PMID: 36212239 PMCID: PMC9534365 DOI: 10.14309/crj.0000000000000868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 08/16/2022] [Indexed: 11/06/2022] Open
Abstract
A 19-year-old man diagnosed with diffuse large B-cell lymphoma undergoing chemotherapy presented for recurrent emesis and weight loss. Imaging studies of the abdomen demonstrated features of superior mesenteric artery syndrome. The patient deferred conservative treatment options and was deemed not to be a surgical candidate. Endoscopic ultrasound-guided gastroenterostomy using a lumen-apposing metal stent was performed to bypass the obstruction. Subsequently, the patient's oral intake and weight significantly improved. The stent was removed 6 months after placement with resolution of superior mesenteric artery syndrome symptoms.
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Jearth V, Rana SS. Endoscopic step up: When and how. Surg Open Sci 2022; 10:135-144. [PMID: 36193259 PMCID: PMC9526220 DOI: 10.1016/j.sopen.2022.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 05/16/2022] [Accepted: 09/12/2022] [Indexed: 11/01/2022] Open
Abstract
The management of (peri)pancreatic collections has undergone a paradigm shift from open surgical drainage to minimally invasive endoscopic, percutaneous, or surgical interventions. Minimally invasive interventions are associated with less morbidity and mortality compared to open necrosectomy. The (peri)pancreatic collections are currently treated with a “step-up approach” of an initial drainage procedure followed, if necessary, by a more invasive debridement. The step-up approach for management of (peri)pancreatic collections is mainly of two types, namely, surgical and endoscopic. Surgical step up includes initial image-guided percutaneous catheter drainage followed, if necessary, by minimally invasive video-assisted retroperitoneal debridement. Endoscopic step-up approach includes endoscopic transluminal drainage followed, if necessary by direct endoscopic necrosectomy. The development of endoscopic ultrasound and lumen apposing metal stents (LAMSs) has revolutionized the endoscopic management of (peri)pancreatic collections. Compared to surgical step-up approach, endoscopic step-up treatment approach has been reported to be associated with less new-onset organ failure, pancreatic fistula, enterocutaneous fistula, or perforation of visceral organ and shorter hospital/intensive care unit stay. This review will mainly focus on indications, techniques, timing, and recent advances related to endoscopic step-up approach in management of symptomatic(peri)pancreatic collections.
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