EUS-guided choledochoduodenostomy using electrocautery-enhanced lumen-apposing metal stents: a French multicenter study after implementation of the technique (with video)

Background and Aims EUS guided biliary drainage is indicated in case of impossibility or failure of classic biliary drainage by ERCP. Recently we reported a good efficiency of EUS-guided choledocoduodenostomy (EUS-CDS) using the ECE-LAMS (electrocautery-enhanced lumen-apposing metal stent) in a retrospective multicentric study. Utilization of the recommended technique (direct punction with the ECE-LAMS using a pure cut current + using a 6 mm stent) was the only predicting factor of clinical success. We reevaluated this procedure after 1 year in the same centers. Methods This was a French retrospective multicentric study of a prospective database including all cases of EUS-guided CDS with ECE-LAMS in the 7 centers that participate in the first study. Results Seventy consecutive patients were included in this study between September 1, 2017 and September 22, 2018. Failure of primary ERCP was due to duodenal stenosis in 44% of cases, tumoral infiltration of the papilla in 22% of cases. The mean duration of the procedure was 5 minutes (±3). The recommended technique was used in 98.5% of cases. The technical and clinical success rate were both 97.1% (69/70). Short-term adverse events (perprocedural + intrahospital) occurred in 1.6%. Conclusions EUS-CDS with the ECE-LAMS is efficacious and safe in distal malignant obstruction of the common bile duct in cases of ERCP failure with impressive results once the expertise is acquired and the recommended technic (direct fistulotomy, pure cut current, and 6 mm stent) is followed.