%0 Journal Article
%A Pérez-Cuadrado-Robles, Enrique
%A Bronswijk, Michiel
%A Prat, Fréderic
%A Barthet, Marc
%A Palazzo, Maxime
%A Arcidiacono, Paolo
%A Schaefer, Marion
%A Devière, Jacques
%A van Wanrooij, Roy L J
%A Tarantino, Ilaria
%A Donatelli, Gianfranco
%A Camus, Marine
%A Sanchez-Yague, Andres
%A Pham, Khanh Do-Cong
%A Gonzalez, Jean-Michel
%A Anderloni, Andrea
%A Vila, Juan J
%A Jezequel, Julien
%A Larghi, Alberto
%A Jaïs, Bénédicte
%A Vazquez-Sequeiros, Enrique
%A Deprez, Pierre H
%A Van der Merwe, Schalk
%A Cellier, Christophe
%A Rahmi, Gabriel
%T Endoscopic ultrasound-guided drainage using lumen-apposing metal stent of malignant afferent limb syndrome in patients with previous Whipple surgery: Multicenter study (with video).
%D 2022
%U http://hdl.handle.net/10668/19935
%X Endoscopic ultrasound-guided digestive anastomosis (EUS-A) is a new alternative under evaluation in patients presenting with afferent limb syndrome (ALS) after Whipple surgery. The aim of the present study is to analyze the safety and effectiveness of EUS-A in ALS. This is an observational multicenter study. All patients ≥18 years old with previous Whipple surgery presenting with ALS who underwent an EUS-A using a lumen-apposing metal stent (LAMS) between 2015 and 2021 were included. The primary outcome was clinical success, defined as resolution of the ALS or ALS-related cholangitis. Furthermore, technical success, adverse event rate, and mortality were evaluated. Forty-five patients (mean age: 65.5 ± 10.2 years; 44.4% male) were included. The most common underlying disease was pancreatic cancer (68.9%). EUS-A was performed at a median of 6 weeks after local tumor recurrence. The most common approach used was the direct/freehand technique (66.7%). Technical success was achieved in 95.6%, with no differences between large (≥15 mm) and small LAMS (97.4% vs. 100%, P = 0.664). Clinical success was retained in 91.1% of patients. A complementary treatment by dilation of the stent followed by endoscopic retrograde cholangiopancreatography through the LAMS was performed in three cases (6.7%). There were six recurrent episodes of cholangitis (14.6%) and two procedure-related adverse events (4.4%) after a median follow-up of 4 months. Twenty-six patients (57.8%) died during the follow-up due to disease progression. EUS-A is a safe and effective technique in the treatment of malignant ALS, achieving high clinical success with an acceptable recurrence rate.
%K LAMS
%K anastomosis
%K endoscopic ultrasound
%K gastrojejunostomy
%K stent
%~