Endoscopic ultrasound-guided choledochoduodenostomy using single-step lumen-apposing metal stents for primary drainage of malignant distal biliary obstruction (SCORPION-p): a prospective pilot study

医学 支架 内镜超声 内镜逆行胰胆管造影术 外科 穿孔 前瞻性队列研究 四分位间距 管腔(解剖学) 入射(几何) 放射科 胰腺炎 冲孔 材料科学 冶金 物理 光学
作者
Jeska A. Fritzsche,Paul Fockens,Marc G. Besselink,Olivier R. Busch,Freek Daams,Nahid S.M. Montazeri,Johanna W. Wilmink,Rogier P. Voermans,Roy L.J. van Wanrooij
出处
期刊:Endoscopy [Georg Thieme Verlag KG]
卷期号:56 (01): 47-52 被引量:1
标识
DOI:10.1055/a-2134-3537
摘要

Background This study aimed to assess the safety and feasibility of endoscopic ultrasound-guided choledochoduodenostomy (EUS-CDS) using a lumen-apposing metal stent (LAMS) as a primary drainage strategy in patients with distal malignant biliary obstruction (MBO). Methods A prospective, single-center, pilot study was conducted in patients with pathology-confirmed MBO without gastric outlet obstruction. The primary outcome was technical success. Secondary outcomes included clinical success, adverse events (AEs), and reinterventions. The study was registered in the Netherlands Trial Registry (registry number NL9757). Results 22 patients were enrolled (median age 69.5 years [interquartile range 64–75.3]). Technical success was achieved in 20/22 patients (91 %). AEs occurred in one patient, namely perforation following inadequate stent deployment (5 %), which was treated in the same procedure. Clinical success was achieved in 19/22 patients (86 %). Stent dysfunction was observed in 11/20 patients (55 %) after technically successful EUS-CDS: two patients were treated conservatively and nine patients underwent reintervention(s). One patient died within ≤ 30 days due to fulminant disease progression. Conclusions The results confirmed the safety and feasibility of EUS-CDS using LAMS as a primary drainage strategy. The high incidence of stent dysfunction should be improved before EUS-CDS with LAMS can be seen as a valid alternative to endoscopic retrograde cholangiopancreatography.

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