PTH-035 EUS-guided biliary and endoluminal drainage by LAMS: initial experience from a HPB/Transplant centre

Introduction Endoscopic ultrasound-guided biliary or enteral drainage is an emerging alternative to managing biliary or enteral obstruction, when endoscopic retrograde cholangiopancreatography (ERCP) or duodenal stenting fail. Recently developed electrocautery-enhanced Lumen-Apposing Metal Stents (LAMS), allow endoscopic anastomosis (Hot AXIOS™ system, Boston Scientific) to facilitate EUS guided choledochojejunostomy or gastrojejunostomy. EUS guided hepaticogastrostomy is also feasible; using a dedicated half covered biliary SEMS (Giobor® stent). The aim of this study was to assess the safety and effectiveness of these stents in gallbladder, biliary and endoluminal drainage where standard approaches have failed. Methods Case series of EUS guided biliary or enteral drainage from a tertiary referral HPB/Liver Transplant centre between January 2017 and January 2019. Results During the 2 year study period, 19 cases were undertaken on 14 patients; 7 Male, 7 Female. Median age 77 (range 34–91). 10 of the patients had malignant disease, 4 benign. Indications included 6 EUS guided biliary drainage with LAMS from D1, 4 EUS guided gallbladder drainage, 3 EUS wire guided rendezvous, 2 EUS guided drainage of an obstructed hepaticojejunostomy, 2 EUS guided gastrojejunostomy, 1 gastrojejunostomy stent change, 1 hepaticogastrostomy. The procedure was clinically successful in 68% (13/19) of cases. Median length of stay post procedure was 4 days (range 1–32). Adverse events occurred in 32% (6/19), 5/6 were small bile leaks, which settled clinically without need for further intervention, one case of stent displacement requiring surgical removal. Conclusion In our experience, EUS-guided LAMS placement for novel applications, performed by experienced endosonographers was safe and feasible in selected cases of benign and malignant disease.