Endoscopic ultrasound-guided gallbladder drainage as a first approach for jaundice palliation in unresectable malignant distal biliary obstruction : Prospective study
© 2023 Japan Gastroenterological Endoscopy Society..
OBJECTIVES: Endoscopic retrograde cholangiopancreatography (ERCP) represents the gold standard for jaundice palliation in patients with distal malignant biliary obstruction (DMBO). Biliary drainage using electrocautery lumen apposing metal stent (EC-LAMS) is currently a well-established procedure when ERCP fails. In a palliative setting the endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) could represent an easy and valid option. We performed a prospective study with a new EC-LAMS with the primary aim to assess the clinical success rate of EUS-GBD as a first-line approach to the palliation of DMBO.
METHODS: In all, 37 consecutive patients undergoing EUS-GBD with a new EC-LAMS were prospectively enrolled. Clinical success was defined as bilirubin level decrease >15% within 24 h and >50% within 14 days after EC-LAMS placement.
RESULTS: The mean age was 73.5 ± 10.8 years; there were 17 male patients (45.9%). EC-LAMS placement was technically feasible in all patients (100%) and the clinical success rate was 100%. Four patients (10.8%) experienced adverse events, one bleeding, one food impaction, and two cystic duct obstructions because of disease progression. No stent-related deaths were observed. The mean hospitalization was 7.7 ± 3.4 days. Median overall survival was 4 months (95% confidence interval 1-8).
CONCLUSION: Endoscopic ultrasound-guided gallbladder drainage with the new EC-LAMS is a valid option in palliative endoscopic biliary drainage as a first-step approach in low survival patients with malignant jaundice unfit for surgery. A smaller diameter EC-LAMS should be preferred, particularly if the drainage is performed through the stomach, to avoid potential food impaction, which could result in stent dysfunction.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2024 |
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| Erschienen: |
2024 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:36 |
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| Enthalten in: |
Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society - 36(2024), 3 vom: 12. März, Seite 351-358 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Mangiavillano, Benedetto [VerfasserIn] |
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| Links: |
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| Themen: |
Drainage: EUS-GBD |
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| Anmerkungen: |
Date Completed 06.03.2024 Date Revised 06.03.2024 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1111/den.14606 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM357553381 |
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| 100 | 1 | |a Mangiavillano, Benedetto |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Endoscopic ultrasound-guided gallbladder drainage as a first approach for jaundice palliation in unresectable malignant distal biliary obstruction |b Prospective study |
| 264 | 1 | |c 2024 | |
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| 500 | |a Date Revised 06.03.2024 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a © 2023 Japan Gastroenterological Endoscopy Society. | ||
| 520 | |a OBJECTIVES: Endoscopic retrograde cholangiopancreatography (ERCP) represents the gold standard for jaundice palliation in patients with distal malignant biliary obstruction (DMBO). Biliary drainage using electrocautery lumen apposing metal stent (EC-LAMS) is currently a well-established procedure when ERCP fails. In a palliative setting the endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) could represent an easy and valid option. We performed a prospective study with a new EC-LAMS with the primary aim to assess the clinical success rate of EUS-GBD as a first-line approach to the palliation of DMBO | ||
| 520 | |a METHODS: In all, 37 consecutive patients undergoing EUS-GBD with a new EC-LAMS were prospectively enrolled. Clinical success was defined as bilirubin level decrease >15% within 24 h and >50% within 14 days after EC-LAMS placement | ||
| 520 | |a RESULTS: The mean age was 73.5 ± 10.8 years; there were 17 male patients (45.9%). EC-LAMS placement was technically feasible in all patients (100%) and the clinical success rate was 100%. Four patients (10.8%) experienced adverse events, one bleeding, one food impaction, and two cystic duct obstructions because of disease progression. No stent-related deaths were observed. The mean hospitalization was 7.7 ± 3.4 days. Median overall survival was 4 months (95% confidence interval 1-8) | ||
| 520 | |a CONCLUSION: Endoscopic ultrasound-guided gallbladder drainage with the new EC-LAMS is a valid option in palliative endoscopic biliary drainage as a first-step approach in low survival patients with malignant jaundice unfit for surgery. A smaller diameter EC-LAMS should be preferred, particularly if the drainage is performed through the stomach, to avoid potential food impaction, which could result in stent dysfunction | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a EC-LAMS | |
| 650 | 4 | |a Hot-Spaxus | |
| 650 | 4 | |a drainage: EUS-GBD | |
| 650 | 4 | |a interventional EUS | |
| 650 | 4 | |a malignant biliary obstruction (MBO) | |
| 700 | 1 | |a Moon, Jong Ho |e verfasserin |4 aut | |
| 700 | 1 | |a Facciorusso, Antonio |e verfasserin |4 aut | |
| 700 | 1 | |a Vargas-Madrigal, Jorge |e verfasserin |4 aut | |
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| 700 | 1 | |a Rizzatti, Gianenrico |e verfasserin |4 aut | |
| 700 | 1 | |a De Luca, Luca |e verfasserin |4 aut | |
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| 700 | 1 | |a Mutignani, Massimiliano |e verfasserin |4 aut | |
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| 700 | 1 | |a Bulajic, Milutin |e verfasserin |4 aut | |
| 700 | 1 | |a Decembrino, Francesco |e verfasserin |4 aut | |
| 700 | 1 | |a Auriemma, Francesco |e verfasserin |4 aut | |
| 700 | 1 | |a Franchellucci, Gianluca |e verfasserin |4 aut | |
| 700 | 1 | |a De Marco, Alessandro |e verfasserin |4 aut | |
| 700 | 1 | |a Gentile, Carmine |e verfasserin |4 aut | |
| 700 | 1 | |a Shin, Il Sang |e verfasserin |4 aut | |
| 700 | 1 | |a Rea, Roberta |e verfasserin |4 aut | |
| 700 | 1 | |a Massidda, Marco |e verfasserin |4 aut | |
| 700 | 1 | |a Calabrese, Federica |e verfasserin |4 aut | |
| 700 | 1 | |a Mirante, Vincenzo Giorgio |e verfasserin |4 aut | |
| 700 | 1 | |a Ofosu, Andrew |e verfasserin |4 aut | |
| 700 | 1 | |a Crinò, Stefano Francesco |e verfasserin |4 aut | |
| 700 | 1 | |a Hassan, Cesare |e verfasserin |4 aut | |
| 700 | 1 | |a Repici, Alessandro |e verfasserin |4 aut | |
| 700 | 1 | |a Larghi, Alberto |e verfasserin |4 aut | |
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