Mangiavillano Benedetto, Moon Jong Ho, Facciorusso Antonio, Di Matteo Francesco, Paduano Danilo, Bulajic Milutin, Ofosu Andrew, Auriemma Francesco, Lamonaca Laura, Yoo Hae Won, Rea Roberta, Massidda Marco, Repici Alessandro
Gastrointestinal Endoscopy Unit - Humanitas Mater Domini - Castellanza (VA), Italy.
Humanitas University, Department of Biomedical Sciences, Pieve Emanuele, Milan, Italy.
Endosc Int Open. 2022 Jul 15;10(7):E998-E1003. doi: 10.1055/a-1838-2683. eCollection 2022 Jul.
Endoscopic retrograde cholangiopancreatography (ERCP) represents the gold standard for jaundice palliation in malignant biliary obstruction (MBO) patients. Biliary drainage using electrocautery lumen apposing metal stent (EC-LAMS) is currently a well-established procedure when ERCP fails. We aimed to assess the technical and clinical success of a new EC-LAMS as the first approach to the palliation of malignant jaundice due to MBO in patients unfit for surgery. Twenty-five consecutive patients undergoing endoscopic-guided biliary drainage with the new EC-LAMS were prospectively enrolled. Clinical success was defined as bilirubin level decrease > 15 % 24 hours after EC-LAMS placement. Mean age was 76.6 ± 11.56 years, and male patients were 10 (40 %). EC-LAMS placement was technically feasible in 24 patients (96 %) and clinical success rate was 100 %. Only one patient (4 %) experienced a misplacement rescued by an immediate second EC-LAMS placement. The mean duration of hospital stay was 4.66 ± 4.22 days. The median overall survival was 7 months (95 % CI 1-7). In this preliminary study, the new EC-LAMS seems to allow a single-step palliative endoscopic therapy in patients affected by jaundice due to MBO, with high technical and clinical success and low adverse events. Further large prospective studies are warranted to validate these results.
内镜逆行胰胆管造影术（ERCP）是恶性胆管梗阻（MBO）患者黄疸姑息治疗的金标准。当ERCP失败时，使用电灼腔内置入金属支架（EC-LAMS）进行胆道引流目前是一种成熟的手术。我们旨在评估一种新型EC-LAMS作为不适于手术的MBO所致恶性黄疸姑息治疗的首次治疗方法的技术和临床成功率。前瞻性纳入了连续25例接受新型EC-LAMS内镜引导下胆道引流的患者。临床成功定义为EC-LAMS置入后24小时胆红素水平下降>15%。平均年龄为76.6±11.56岁，男性患者10例（40%）。24例患者（96%）的EC-LAMS置入在技术上可行，临床成功率为100%。仅1例患者（4%）发生误置，通过立即再次置入EC-LAMS得以挽救。平均住院时间为4.66±4.22天。中位总生存期为7个月（95%CI 1-7）。在这项初步研究中，新型EC-LAMS似乎能够为因MBO导致黄疸的患者提供单步姑息性内镜治疗，技术和临床成功率高，不良事件少。需要进一步进行大型前瞻性研究来验证这些结果。
