Endoscopic ultrasonography-guided biliary drainage for malignant jaundice by using electrocautery-enhanced lumen-apposing metal stents (Hot-SPAXUS stent)

Raffaele Manta; Sabrina Torrisi; Danilo Castellani; Ugo Germani; Francesco P. Zito; Olivia Morelli; Paolo M. Brunori; Angelo Zullo; Vincenzo De Francesco

Authors Raffaele Manta, Sabrina Torrisi, Danilo Castellani, Ugo Germani, Francesco P. Zito, Olivia Morelli, Paolo M. Brunori, Angelo Zullo, Vincenzo De Francesco.

Abstract

Background Biliary drainage with endoscopic retrograde cholangiopancreatography (ERCP) for tumoral jaundice fails in a certain percentage of patients. In these patients, endoscopic ultrasonography-guided lumen-apposing metal stents (LAMS) with electrocautery-enhanced (ECE) technology allows a single-step, radiation-free palliative treatment.

Methods We reviewed the data of patients who underwent choledochoduodenostomy with placement of ECE-LAMS (Hot-SPAXUS stent) after ERCP failure in a single tertiary center. Technical and clinical success rates were calculated and adverse events recorded.

Results Data of 15 patients (8 male, median age 72 years) were collected. The procedure was technically successful in all patients, whilst clinical success was achieved in 14 (93.3%) patients. One (6.7%) patient presented delayed bleeding treated endoscopically. At follow up, stent occlusion with recurrence of jaundice occurred in 2 (13.3%) patients, due to food impaction (n=1), or neoplastic ingrowth (n=1).

Conclusion Our results suggest that the Hot-SPAXUS procedure is effective and safe for palliative treatment in patients with distal biliary malignant obstruction after failure of ERCP.

Keywords Biliary drainage, obstructive jaundice, electrocautery-enhanced lumen-apposing metal stents, endoscopic ultrasonography

Ann Gastroenterol 2022; 35 (6): 663-667