PMID- 36177532 OWN - NLM STAT- MEDLINE DCOM- 20230310 LR - 20230310 IS - 1443-1661 (Electronic) IS - 0915-5635 (Linking) VI - 35 IP - 3 DP - 2023 Mar TI - Classification, risk factors, and management of lumen apposing metal stent dysfunction during follow-up of endoscopic ultrasound-guided choledochoduodenostomy: Multicenter evaluation from the Leuven-Amsterdam-Milan Study Group. PG - 377-388 LID - 10.1111/den.14445 [doi] AB - OBJECTIVES: Long-term outcomes of endoscopic ultrasound-guided choledochoduodenostomy (EUS-CDS) performed with lumen apposing metal stents (LAMS) have been poorly evaluated in small or retrospective series, leading to an underestimation of LAMS dysfunction. METHODS: All consecutive EUS-CDS performed in three academic referral centers were included in prospectively maintained databases. Technical/clinical success, adverse events (AEs), and dysfunction during follow-up were retrospectively analyzed. Kaplan-Meier analysis was used to estimate dysfunction-free survival (DFS), with Cox proportional hazard regression to evaluate independent predictors of dysfunction. RESULTS: Ninety-three patients were included (male 56%; mean age, 70 years [95% confidence interval (CI) 68-72]; pancreatic cancer 81%, metastatic disease 47%). In 67% of procedures, 6 mm LAMS were used. Technical and clinical success were achieved in 97.8% and 93.4% of patients, respectively, with AEs occurring in 9.7% (78% mild/moderate). Dysfunction occurred in 31.8% of patients after a mean of 166 days (95% CI 91-241), with an estimated 6 month and 12 month DFS of 75% and 52%, respectively; mean DFS of 394 (95% CI 307-482) days. Almost all dysfunctions (96%) were successfully managed by endoscopic reintervention. Duodenal invasion (hazard ratio 2.7 [95% CI 1.1-6.8]) was the only independent predictor of dysfunction. CONCLUSIONS: Endoscopic ultrasound-guided choledochoduodenostomy shows excellent initial efficacy and safety, although stent dysfunctions occurs frequently during long-term follow-up. Almost all stent dysfunctions can be managed successfully by endoscopic reinterventions. We propose a comprehensive classification of the different types of dysfunction that may be encountered and rescue procedures that may be employed under these circumstances. Duodenal invasion seems to increase the risk of developing EUS-CDS dysfunction, potentially representing a relative contraindication for this technique. CI - (c) 2022 The Authors. Digestive Endoscopy published by John Wiley & Sons Australia, Ltd on behalf of Japan Gastroenterological Endoscopy Society. FAU - Vanella, Giuseppe AU - Vanella G AUID- ORCID: 0000-0001-7280-1761 AD - Pancreatobiliary Endoscopy and Endosonography Division, Pancreas Translational and Clinical Research Centre, IRCCS San Raffaele Scientific Institute and University, Milan, Italy. FAU - Bronswijk, Michiel AU - Bronswijk M AUID- ORCID: 0000-0003-2039-5022 AD - Department of Gastroenterology and Hepatology, University Hospitals Gasthuisberg, University of Leuven, Leuven, Belgium. AD - Department of Gastroenterology and Hepatology, Imelda General Hospital, Bonheiden, Belgium. FAU - Dell'Anna, Giuseppe AU - Dell'Anna G AD - Pancreatobiliary Endoscopy and Endosonography Division, Pancreas Translational and Clinical Research Centre, IRCCS San Raffaele Scientific Institute and University, Milan, Italy. FAU - Voermans, Rogier P AU - Voermans RP AD - Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, The Netherlands. FAU - Laleman, Wim AU - Laleman W AD - Department of Gastroenterology and Hepatology, University Hospitals Gasthuisberg, University of Leuven, Leuven, Belgium. FAU - Petrone, Maria Chiara AU - Petrone MC AD - Pancreatobiliary Endoscopy and Endosonography Division, Pancreas Translational and Clinical Research Centre, IRCCS San Raffaele Scientific Institute and University, Milan, Italy. FAU - van Malenstein, Hannah AU - van Malenstein H AD - Department of Gastroenterology and Hepatology, University Hospitals Gasthuisberg, University of Leuven, Leuven, Belgium. FAU - Fockens, Paul AU - Fockens P AD - Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, The Netherlands. AD - Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, Vrije Universiteit, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, The Netherlands. FAU - Arcidiacono, Paolo Giorgio AU - Arcidiacono PG AD - Pancreatobiliary Endoscopy and Endosonography Division, Pancreas Translational and Clinical Research Centre, IRCCS San Raffaele Scientific Institute and University, Milan, Italy. FAU - van der Merwe, Schalk AU - van der Merwe S AD - Department of Gastroenterology and Hepatology, University Hospitals Gasthuisberg, University of Leuven, Leuven, Belgium. FAU - van Wanrooij, Roy L J AU - van Wanrooij RLJ AD - Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, Vrije Universiteit, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, The Netherlands. LA - eng PT - Journal Article PT - Multicenter Study DEP - 20221109 PL - Australia TA - Dig Endosc JT - Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society JID - 9101419 SB - IM MH - Humans MH - Male MH - Aged MH - *Choledochostomy/adverse effects/methods MH - Retrospective Studies MH - Follow-Up Studies MH - *Cholestasis/diagnostic imaging/etiology/surgery MH - Endosonography/methods MH - Stents/adverse effects MH - Ultrasonography, Interventional/methods MH - Risk Factors MH - Drainage/methods MH - Treatment Outcome OTO - NOTNLM OT - biliary drainage OT - choledochostomy OT - pancreatic neoplasm OT - stent OT - therapeutic endoscopic ultrasound EDAT- 2022/10/01 06:00 MHDA- 2023/03/11 06:00 CRDT- 2022/09/30 02:53 PHST- 2022/07/03 00:00 [received] PHST- 2022/09/26 00:00 [accepted] PHST- 2022/10/01 06:00 [pubmed] PHST- 2023/03/11 06:00 [medline] PHST- 2022/09/30 02:53 [entrez] AID - 10.1111/den.14445 [doi] PST - ppublish SO - Dig Endosc. 2023 Mar;35(3):377-388. doi: 10.1111/den.14445. Epub 2022 Nov 9.