Traditionally, malignant biliary obstruction is relieved by placing a transpapillary stent during endoscopic retrograde cholangioscopy (ERCP). Pancreatitis is a possible adverse event of ERCP. Additionally, stent obstruction is increasingly observed in patients because of improved survival, necessitating another procedure. Endoscopic ultrasound-guided choledochoduodenostomy (EUS-CDS) with a lumen-apposing metal stent is an option in patients with malignant distal biliary obstruction (MDBO). This approach avoids pancreatitis and possibly the need for a repeat procedure. This procedure usually is reserved for patients for whom ERCP has been unsuccessful. This multicenter, randomized controlled trial compared outcomes of upfront EUS-CDS with those of ERCP with metal stenting (ERCP-M) in patients with MDBO. <\/p>\n\n\n\n
From February 2019 to February 2022, 144 patients from 11 institutions were randomized to EUS-CDS or ERCP-M (n=73 vs 71, respectively). All patients had borderline resectable, locally advanced, or unresectable disease. This was a noninferiority assessment of technical success. The primary outcome was the rate of stent dysfunction caused by migration or stent blockage that required reintervention at one year. Secondary outcomes included technical success, initial clinical success, and adverse events. The investigators performed intention-to-treat analyses. <\/p>\n\n\n\n
There was no difference in stent dysfunction between groups (9.6% vs 9.9% of EUS-CDS and ERCP-M cases, respectively [P<\/em>=.96]). Technical success was achieved in 90.4% (95% confidence interval [CI], 81.5%-95.3%) of EUS-CDS procedures and 83.1% (95% CI, 72.7%-90.1%) of ERCP-M, with a risk difference of 7.3% (95% CI, -4.0% to 18.8%), indicating noninferiority. The mean procedure time was 14.0 \u00b1 11.4 minutes with EUS-CDS versus 23.1 \u00b1 15.6 minutes with ERCP-M (P<\/em><.01). Fluoroscopy was not used in 40% of the EUS-CDS procedures. There were no differences in adverse events, pancreaticoduodenectomy, oncological outcomes, or quality of life.<\/p>\n","protected":false},"excerpt":{"rendered":" Traditionally, malignant biliary obstruction is relieved by placing a transpapillary stent during endoscopic retrograde cholangioscopy (ERCP). Pancreatitis is a possible adverse event of ERCP. Additionally, stent obstruction is increasingly observed in patients because of improved survival, necessitating another procedure. Endoscopic ultrasound-guided choledochoduodenostomy (EUS-CDS) with a lumen-apposing metal stent is an option in patients with malignant … Read more<\/a><\/p>\n","protected":false},"template":"","categories":[1768,2052],"tags":[3843,381,3848,625,3846,3844,3845,3847],"class_list":["post-14542","ec-news","type-ec-news","status-publish","hentry","category-asge-journal-scan","category-eus","tag-endoscopic-retrograde-cholangioscopy","tag-ercp","tag-ercp-m","tag-eus","tag-eus-cds","tag-malignant-distal-biliary-obstruction","tag-mdbo","tag-metal-stenting"],"_links":{"self":[{"href":"https:\/\/www.endoscopy-campus.com\/en\/wp-json\/wp\/v2\/ec-news\/14542","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.endoscopy-campus.com\/en\/wp-json\/wp\/v2\/ec-news"}],"about":[{"href":"https:\/\/www.endoscopy-campus.com\/en\/wp-json\/wp\/v2\/types\/ec-news"}],"wp:attachment":[{"href":"https:\/\/www.endoscopy-campus.com\/en\/wp-json\/wp\/v2\/media?parent=14542"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.endoscopy-campus.com\/en\/wp-json\/wp\/v2\/categories?post=14542"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.endoscopy-campus.com\/en\/wp-json\/wp\/v2\/tags?post=14542"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}