Su1285 ENDOSCOPIC ULTRASOUND GUIDED BILIARY DRAINAGE (EUS-BD) WITH LUMEN APPOSING METAL STENTS FOR MALIGNANT BILIARY OBSTRUCTION: A MULTICENTER NORTH AMERICAN EXPERIENCE

Endoscopic Ultrasound guided biliary drainage (EUS-BD) has been demonstrated as a safe and effective alternative to Endoscopic Retrograde Cholangiopancreatography (ERCP) in malignant biliary obstruction. Various plastic and metal stents have previously been used for drainage, with recently increasing use of lumen apposing metal stents (LAMS). However there is limited data to guide patient selection, choice of stent, or method of placement. This study examines the rates of technical success, clinical success, and adverse events associated with the use of LAMS for EUS-BD. A retrospective study was conducted at 10 institutions. It included all cases of biliary obstruction that EUS-BD was performed using a LAMS. Collected data points were clinical and technical factors, adverse events and mortality. Main outcomes were technical success (defined as successful LAMS placement), clinical success (50% decline in bilirubin at 2 weeks), recurrence of biliary obstruction, and adverse events. 72 patients were included with median follow up of 56 days. Descriptive data is in Table 1 and Table 2. Most obstructions (89%) were at the distal common bile duct and the main etiology was pancreatic cancer (82%). Mean pre-procedure bilirubin was 19.2 mg/dl and common bile duct size was 22.7 mm. ERCP was attempted initially in 47% of patients. In patients where technical success (97%) was achieved, 100% clinical resolution was noted. Median time to clinical success was 1 day. Biliary obstruction recurred in 6% of cases, though no predicting factors were identified. A total of 9 (12.5%) (6 mild, 1 moderate, 2 severe) non-LAMS related adverse events were reported. There were 11 (15%) LAMS associated adverse events (6 food impaction, 4 bleeding, 1 migration). Elective LAMS removal without fistula closure was performed in 3 cases and was not associated with recurrent biliary obstruction or adverse events. 17% of patients died during follow up but no deaths were attributed to the procedure. EUS-BD with LAMS is effective in relieving malignant biliary obstruction with low rates of recurrence. There was high technical success with this procedure and this resulted in clinical resolution in all successful cases. No other clinical or technical factors were associated with initial technical or clinical success, recurrent biliary obstruction or adverse events. Further prospective studies are needed to validate these findings and generate longer term data.Table 2Technical OutcomesView Large Image Figure ViewerDownload Hi-res image Download (PPT)