Common bile duct size in malignant distal obstruction and lumen-apposing metal stents: a multicenter prospective study
Background and study aims Feasibility of EUS-guided choledochoduodenostomy (EUS-CDS) using available lumen-apposing stents (LAMS) is limited by the size of the common bile duct (CBD) (≤ 12 mm, cut-off for experts; 15 mm, cut-off for non-experts). We aimed to assess the prevalence and predictive fact...
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Georg Thieme Verlag KG
2021
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oai:doaj.org-article:0690ff1c640647c9829f2c12000a43232021-11-13T00:00:31ZCommon bile duct size in malignant distal obstruction and lumen-apposing metal stents: a multicenter prospective study2364-37222196-973610.1055/a-1526-1208https://doaj.org/article/0690ff1c640647c9829f2c12000a43232021-11-01T00:00:00Zhttp://www.thieme-connect.de/DOI/DOI?10.1055/a-1526-1208https://doaj.org/toc/2364-3722https://doaj.org/toc/2196-9736Background and study aims Feasibility of EUS-guided choledochoduodenostomy (EUS-CDS) using available lumen-apposing stents (LAMS) is limited by the size of the common bile duct (CBD) (≤ 12 mm, cut-off for experts; 15 mm, cut-off for non-experts). We aimed to assess the prevalence and predictive factors associated with CBD size ≥ 12 and 15 mm in naïve patients with malignant distal biliary obstruction (MDBO). Patients and methods This was a prospective cohort study involving 22 centers with assessment of CBD diameter and subjective feasibility of the EUS-CDS performance in naïve jaundiced patients undergoing EUS evaluation for MDBO. Results A total of 491 patients (mean age 69 ± 12 years) with mean serum bilirubin of 12.7 ± 6.6 mg/dL entered the final analysis. Dilation of the CBD ≥ 12 and 15 mm was detected in 78.8 % and 51.9 % of cases, respectively. Subjective feasibility of EUS-CDS was expressed by endosonographers in 91.2 % for a CBD ≥ 12 mm and in 96.5 % for a CBD ≥ 15 mm. On multivariate analysis, age (P < 0.01) and bilirubin level (P ≤ 0.001) were the only factors associated with both CBD dilation ≥ 12 and ≥ 15 mm. These variables were poorly associated with the extent of duct dilation; however, based on them a prediction model could be constructed that satisfactorily predicted CBD size ≥ 12 mm in patients at least 70 years and a bilirubin level ≥ 7 mg/dL. Conclusions Our study showed that at presentation in a large cohort of patients with MDBO, EUS-CDS can be potentially performed in three quarters to half of cases by expert and less experienced endosonographers, respectively. Dedicated stents or devices with different designs able to overcome the limitations of existing electrocautery-enhanced LAMS for EUS-CDS are needed.Mihai RimbaşAndrea AnderloniBertrand NapoléonAndrada SeiceanEdoardo FortiStefano Francesco CrinòIlaria TarantinoPaolo Giorgio ArcidiaconoCarlo FabbriGianenrico RizzattiArnaldo AmatoTheodor VoiosuAlessandro FugazzaOfelia MoșteanuÀngels GinèsGermana de NucciPietro FusaroliNam Quoc NguyenRoberto Di MitriLeonardo Minelli GrazioliMassimiliano MutignaniLivia ArchibugiCecilia BindaAnna CominardiCarmelo BarberaGlòria Fernández-EsparrachLaurent PalazzoMaxime PalazzoJan Werner PoleyCristiano SpadaGiorgio ValeriiTakao ItoiYukitoshi MatsunamiRadu Bogdan MateescuCristian BăicușGuido CostamagnaAlberto LarghiGeorg Thieme Verlag KGarticleDiseases of the digestive system. GastroenterologyRC799-869ENEndoscopy International Open, Vol 09, Iss 11, Pp E1801-E1810 (2021) |
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DOAJ |
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DOAJ |
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EN |
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Diseases of the digestive system. Gastroenterology RC799-869 |
| spellingShingle |
Diseases of the digestive system. Gastroenterology RC799-869 Mihai Rimbaş Andrea Anderloni Bertrand Napoléon Andrada Seicean Edoardo Forti Stefano Francesco Crinò Ilaria Tarantino Paolo Giorgio Arcidiacono Carlo Fabbri Gianenrico Rizzatti Arnaldo Amato Theodor Voiosu Alessandro Fugazza Ofelia Moșteanu Àngels Ginès Germana de Nucci Pietro Fusaroli Nam Quoc Nguyen Roberto Di Mitri Leonardo Minelli Grazioli Massimiliano Mutignani Livia Archibugi Cecilia Binda Anna Cominardi Carmelo Barbera Glòria Fernández-Esparrach Laurent Palazzo Maxime Palazzo Jan Werner Poley Cristiano Spada Giorgio Valerii Takao Itoi Yukitoshi Matsunami Radu Bogdan Mateescu Cristian Băicuș Guido Costamagna Alberto Larghi Common bile duct size in malignant distal obstruction and lumen-apposing metal stents: a multicenter prospective study |
| description |
Background and study aims Feasibility of EUS-guided choledochoduodenostomy (EUS-CDS) using available lumen-apposing stents (LAMS) is limited by the size of the common bile duct (CBD) (≤ 12 mm, cut-off for experts; 15 mm, cut-off for non-experts). We aimed to assess the prevalence and predictive factors associated with CBD size ≥ 12 and 15 mm in naïve patients with malignant distal biliary obstruction (MDBO).
Patients and methods This was a prospective cohort study involving 22 centers with assessment of CBD diameter and subjective feasibility of the EUS-CDS performance in naïve jaundiced patients undergoing EUS evaluation for MDBO.
Results A total of 491 patients (mean age 69 ± 12 years) with mean serum bilirubin of 12.7 ± 6.6 mg/dL entered the final analysis. Dilation of the CBD ≥ 12 and 15 mm was detected in 78.8 % and 51.9 % of cases, respectively. Subjective feasibility of EUS-CDS was expressed by endosonographers in 91.2 % for a CBD ≥ 12 mm and in 96.5 % for a CBD ≥ 15 mm. On multivariate analysis, age (P < 0.01) and bilirubin level (P ≤ 0.001) were the only factors associated with both CBD dilation ≥ 12 and ≥ 15 mm. These variables were poorly associated with the extent of duct dilation; however, based on them a prediction model could be constructed that satisfactorily predicted CBD size ≥ 12 mm in patients at least 70 years and a bilirubin level ≥ 7 mg/dL.
Conclusions Our study showed that at presentation in a large cohort of patients with MDBO, EUS-CDS can be potentially performed in three quarters to half of cases by expert and less experienced endosonographers, respectively. Dedicated stents or devices with different designs able to overcome the limitations of existing electrocautery-enhanced LAMS for EUS-CDS are needed. |
| format |
article |
| author |
Mihai Rimbaş Andrea Anderloni Bertrand Napoléon Andrada Seicean Edoardo Forti Stefano Francesco Crinò Ilaria Tarantino Paolo Giorgio Arcidiacono Carlo Fabbri Gianenrico Rizzatti Arnaldo Amato Theodor Voiosu Alessandro Fugazza Ofelia Moșteanu Àngels Ginès Germana de Nucci Pietro Fusaroli Nam Quoc Nguyen Roberto Di Mitri Leonardo Minelli Grazioli Massimiliano Mutignani Livia Archibugi Cecilia Binda Anna Cominardi Carmelo Barbera Glòria Fernández-Esparrach Laurent Palazzo Maxime Palazzo Jan Werner Poley Cristiano Spada Giorgio Valerii Takao Itoi Yukitoshi Matsunami Radu Bogdan Mateescu Cristian Băicuș Guido Costamagna Alberto Larghi |
| author_facet |
Mihai Rimbaş Andrea Anderloni Bertrand Napoléon Andrada Seicean Edoardo Forti Stefano Francesco Crinò Ilaria Tarantino Paolo Giorgio Arcidiacono Carlo Fabbri Gianenrico Rizzatti Arnaldo Amato Theodor Voiosu Alessandro Fugazza Ofelia Moșteanu Àngels Ginès Germana de Nucci Pietro Fusaroli Nam Quoc Nguyen Roberto Di Mitri Leonardo Minelli Grazioli Massimiliano Mutignani Livia Archibugi Cecilia Binda Anna Cominardi Carmelo Barbera Glòria Fernández-Esparrach Laurent Palazzo Maxime Palazzo Jan Werner Poley Cristiano Spada Giorgio Valerii Takao Itoi Yukitoshi Matsunami Radu Bogdan Mateescu Cristian Băicuș Guido Costamagna Alberto Larghi |
| author_sort |
Mihai Rimbaş |
| title |
Common bile duct size in malignant distal obstruction and lumen-apposing metal stents: a multicenter prospective study |
| title_short |
Common bile duct size in malignant distal obstruction and lumen-apposing metal stents: a multicenter prospective study |
| title_full |
Common bile duct size in malignant distal obstruction and lumen-apposing metal stents: a multicenter prospective study |
| title_fullStr |
Common bile duct size in malignant distal obstruction and lumen-apposing metal stents: a multicenter prospective study |
| title_full_unstemmed |
Common bile duct size in malignant distal obstruction and lumen-apposing metal stents: a multicenter prospective study |
| title_sort |
common bile duct size in malignant distal obstruction and lumen-apposing metal stents: a multicenter prospective study |
| publisher |
Georg Thieme Verlag KG |
| publishDate |
2021 |
| url |
https://doaj.org/article/0690ff1c640647c9829f2c12000a4323 |
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