학술논문
Endoscopic ultrasound‐guided gallbladder drainage as a first approach for jaundice palliation in unresectable malignant distal biliary obstruction: Prospective study.
Document Type
Article
Author
Mangiavillano, Benedetto; Moon, Jong Ho; Facciorusso, Antonio; Vargas‐Madrigal, Jorge; Di Matteo, Francesco; Rizzatti, Gianenrico; De Luca, Luca; Forti, Edoardo; Mutignani, Massimiliano; Al‐Lehibi, Abed; Paduano, Danilo; Bulajic, Milutin; Decembrino, Francesco; Auriemma, Francesco; Franchellucci, Gianluca; De Marco, Alessandro; Gentile, Carmine; Shin, Il Sang; Rea, Roberta; Massidda, Marco
Source
Subject
*ENDOSCOPIC ultrasonography
*GALLBLADDER
*DRAINAGE
*ENDOSCOPIC retrograde cholangiopancreatography
*JAUNDICE
*LONGITUDINAL method
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Language
ISSN
0915-5635
Abstract
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. [ABSTRACT FROM AUTHOR]