Endoscopic ultrasound‐guided drainage using lumen‐apposing metal stent of malignant afferent limb syndrome in patients with previous Whipple surgery: Multicenter study (with video) - Archive ouverte HAL Accéder directement au contenu
Article Dans Une Revue Digestive Endoscopy Année : 2022

Endoscopic ultrasound‐guided drainage using lumen‐apposing metal stent of malignant afferent limb syndrome in patients with previous Whipple surgery: Multicenter study (with video)

Michiel Bronswijk
Maxime Palazzo
  • Fonction : Auteur
Paolo Arcidiacono
  • Fonction : Auteur
Roy van Wanrooij
  • Fonction : Auteur
Ilaria Tarantino
  • Fonction : Auteur
Gianfranco Donatelli
Andres Sanchez-Yague
  • Fonction : Auteur
Khanh Do‐cong Pham
  • Fonction : Auteur
Andrea Anderloni
  • Fonction : Auteur
Juan Vila
  • Fonction : Auteur
Alberto Larghi
  • Fonction : Auteur
Enrique Vazquez-Sequeiros
  • Fonction : Auteur
Pierre Deprez
Schalk van der Merwe
  • Fonction : Auteur
Christophe Cellier
  • Fonction : Auteur
Gabriel Rahmi
  • Fonction : Auteur

Résumé

Objectives Endoscopic ultrasound-guided digestive anastomosis (EUS-A) is a new alternative under evaluation in patients presenting with afferent limb syndrome (ALS) after Whipple surgery. The aim of the present study is to analyze the safety and effectiveness of EUS-A in ALS. Methods This is an observational multicenter study. All patients >= 18 years old with previous Whipple surgery presenting with ALS who underwent an EUS-A using a lumen-apposing metal stent (LAMS) between 2015 and 2021 were included. The primary outcome was clinical success, defined as resolution of the ALS or ALS-related cholangitis. Furthermore, technical success, adverse event rate, and mortality were evaluated. Results Forty-five patients (mean age: 65.5 +/- 10.2 years; 44.4% male) were included. The most common underlying disease was pancreatic cancer (68.9%). EUS-A was performed at a median of 6 weeks after local tumor recurrence. The most common approach used was the direct/freehand technique (66.7%). Technical success was achieved in 95.6%, with no differences between large (>= 15 mm) and small LAMS (97.4% vs. 100%, P = 0.664). Clinical success was retained in 91.1% of patients. A complementary treatment by dilation of the stent followed by endoscopic retrograde cholangiopancreatography through the LAMS was performed in three cases (6.7%). There were six recurrent episodes of cholangitis (14.6%) and two procedure-related adverse events (4.4%) after a median follow-up of 4 months. Twenty-six patients (57.8%) died during the follow-up due to disease progression. Conclusion EUS-A is a safe and effective technique in the treatment of malignant ALS, achieving high clinical success with an acceptable recurrence rate.

Dates et versions

hal-04067464 , version 1 (13-04-2023)

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Enrique Pérez-Cuadrado-Robles, Michiel Bronswijk, Fréderic Prat, Marc Barthet, Maxime Palazzo, et al.. Endoscopic ultrasound‐guided drainage using lumen‐apposing metal stent of malignant afferent limb syndrome in patients with previous Whipple surgery: Multicenter study (with video). Digestive Endoscopy, 2022, 34 (7), pp.1433-1439. ⟨10.1111/den.14330⟩. ⟨hal-04067464⟩
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