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Lumen-apposing metal stents for malignant biliary obstruction: Is this the ultimate horizon of our experience?

World Journal of Gastroenterology 2019年第29期25卷 3857-3869页

作者： Andrea Anderloni Edoardo Troncone Alessandro Fugazza Annalisa Cappello Giovanna Del Vecchio Blanco Giovanni Monteleone Alessandro Repici Digestive Endoscopy Unit Division of Gastroenterology Humanitas Research Hospital Milan 20089 Italy Department of Systems Medicine University of Rome “Tor Vergata” Rome 00133 Italy Digestive Endoscopy Unit Division of Gastroenterology Humanitas University Milan 20089 Italy

In the last years, endoscopic ultrasonography (EUS) has evolved from a purely diagnostic technique to a more and more complex interventional procedure, with the possibility to perform several type of therapeutic interventions. Among these, EUS-guided biliary drainage (BD) is gaining popularity as a therapeutic approach after failed endoscopic retrograde cholangiopancreatography in distal malignant biliary obstruction (MBO), due to the avoidance of external drainage, a lower rate of adverse events and re-interventions, and lower costs compared to percutaneous trans-hepatic BD. Initially, devices created for luminal procedures (e.g., luminal biliary stents) have been adapted to the new trans-luminal EUSguided interventions, with predictable shortcomings in technical success, outcome and adverse events. More recently, new metal stents specifically designed for transluminal drainage, namely lumen-apposing metal stents (LAMS), have been made available for EUS-guided procedures. An electrocautery enhanced delivery system (EC-LAMS), which allows direct access of the delivery system to the target lumen, has subsequently simplified the classic multi-step procedure of EUS-guided drainages. EUS-BD using LAMS and ECLAMS has been demonstrated effective and safe, and currently seems one of the most performing techniques for EUS-BD. In this Review, we summarize the evolution of the EUS-BD in distal MBO, focusing on the novelty of LAMS and analyzing the unresolved questions about the possible role of EUS as the first therapeutic option to achieve BD in this setting of patients.

关键词： Interventional endoscopic ultrasonography Endoscopic ultrasonography-guided biliary drainage Endoscopic ultrasonography-guided choledocho-duodenostomy Biliary metal stent Lumen-apposing metal stent

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