Abstract
P182 Primary endoscopic ultrasound-guided choledochoduodenostomy as a novel and effective method for biliary decompression in malignant biliary obstruction -experience from RWHT
Gut, Vol.73(Suppl 1), pp.A160-A161
06/01/2024
DOI: 10.1136/gutjnl-2024-BSG.264
Abstract
Introduction ERCP with biliary stenting is currently the standard of care in patients malignant biliary obstruction (MBO). EUS-guided choledochoduodenal stenting (EUS-CDS) is a recent and novel technique to facilitate biliary decompression in MBO, with studies demonstrating comparable success and safety profile to ERCP. In patients with malignant obstruction, ERCP can be difficult and have high failure rates. In selected patients, primary EUS-CDS can be a safe and effective modality with good success rates.
Methods Data on patients who underwent EUS-CDS at The Royal Wolverhampton NHS Trust for MBO since Jan 2022 was collected with follow up data for at least 90 days. Technical success was defined as the successful placement of the LAMS into the common bile duct (CBD) from the duodenum. Clinical success was defined as an at least and sustained decrease (≥50% ) in bilirubin 48 h post procedure. 6 and 8mm Hot Axios (Boston Scientific, USA) lumen apposing metal stents (LAMS) were used for EUS-CDS.
Results Twenty eight patients underwent EUS-CDS (mean age 74 years, 18 (62%) males). Twenty two patients (78%) had pancreatic cancer, and four (14%) had duodenal cancer and two had mets or other cancers. Out of 26 patients where staging of disease was available, 11 (42.3%) had metastatic disease, 12 (46.1%) had locally advanced disease and 3 had borderline resectable disease. EUS-CDS was delivered by two operators.
16/28 (57%) had EUS-CDS at the time of their index EUS intervention (Primary EUS CDS) owing to rapid worsening of jaundice and nine patients (32%) underwent EUS-CDS due to duodenal stenosis. Three patients underwent EUS-CDS due to failed ERCP. Majority (89%) underwent 6mm LAMS insertion whilst 3 patients (12%) had 8mm LAMS.
Technical success was achieved at initial LAMS insertion in 27 patients (96%), with deployment failure in one patient, which was managed by re-deploying a new stent. Clinical success was achieved in 100% in cases. Two (7.1%) patients had adverse events (mild cholangitis, transient bleeding managed conservatively). 30-day survival was 76% and 90-day survival was 52%.
Conclusions EUS-CDS is a safe and effective technique and is complementary to ERCP in the armamentarium of tools required for biliary decompression for MBO. In selective group of patients, primary EUS CDS is effective modality with high technical and clinical success.
Details
- Title: Subtitle
- P182 Primary endoscopic ultrasound-guided choledochoduodenostomy as a novel and effective method for biliary decompression in malignant biliary obstruction -experience from RWHT
- Creators
- Abdullah AbbasiRay MathewRaheel AnjumMalik MagrabiMuhammad SaadShyam Menon
- Resource Type
- Abstract
- Publication Details
- Gut, Vol.73(Suppl 1), pp.A160-A161
- Publisher
- BMJ Publishing Group LTD
- DOI
- 10.1136/gutjnl-2024-BSG.264
- ISSN
- 0017-5749
- eISSN
- 1468-3288
- Language
- English
- Date published
- 06/01/2024
- Academic Unit
- Internal Medicine
- Record Identifier
- 9984843739102771
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