Background EUS-guided choledoco-duodenostomy using electrocautery-enhanced lumen-apposing metal stents (ECE-LAMS) is becoming the gold standard in case of endoscopic retrograde cholangio-pancreatography failure for distal malignant obstruction. Long-term data in larger samples are lacking. Methods This was a prospective monocentric study including all patients who underwent EUS-guided choledochoduodenostomy (CDS) between September 2016 and December 2021. The primary endpoint was the rate of biliary obstruction during follow-up. Secondary endpoints were technical and clinical success rates, adverse event rates, and identification of risk factors for biliary obstruction. Results One hundred and twenty-three EUS-guided CDS using ECE-LAMS were performed at Limoges University Hospital were performed during the study period and included in the study. The main cause of obstruction was pancreatic adenocarcinoma in 91 (74.5%) cases. The technical and clinical success rates were 97.5% and 91%, respectively. Twenty patients (16.3%) suffered from biliary obstructions during a mean follow-up of 242 days. The clinical success rate for endoscopic desobstruction was 80% (16/20). In uni- and multivariate analyses, only the presence of a duodenal stent (odds ratio [OR]: 3.6, 95% confidence interval [CI] 95%: 1.2-10.2; P = 0.018) and a bile duct thinner than 15 mm (OR: 3.9, CI 95%: 1.3-11.7; P = 0.015) were the significant risk factors for biliary obstruction during the follow-up. Conclusion Obstruction of LAMS occurred in 16.3% of cases during follow-up and endoscopic desobstruction is efficacious in 80% of cases. The presence of duodenal stent and a bile duct thinner than 15 mm are the risk factors of obstruction. Except in these situation, EUS-CDS with ECE-LAMS could be proposed in the first intent in case of distal malignant obstruction.

中文翻译：

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使用内腔金属支架进行 EUS 引导胆道引流后长期随访期间支架功能障碍的危险因素：一项前瞻性研究。

背景EUS引导下使用电灼增强管腔放置金属支架（ECE-LAMS）的胆总管十二指肠吻合术正在成为远端恶性梗阻内镜逆行胰胆管造影失败的金标准。缺乏较大样本的长期数据。方法 这是一项前瞻性单中心研究，包括 2016 年 9 月至 2021 年 12 月期间接受超声内镜引导下胆总管十二指肠吻合术 (CDS) 的所有患者。主要终点是随访期间胆道梗阻的发生率。次要终点是技术和临床成功率、不良事件发生率以及胆道梗阻危险因素的识别。结果 研究期间在利摩日大学医院进行了 123 例使用 ECE-LAMS 的 EUS 引导 CDS，并纳入研究。91例（74.5%）梗阻的主要原因是胰腺癌。技术和临床成功率分别为97.5%和91%。在平均 242 天的随访期间，20 名患者 (16.3%) 出现胆道梗阻。内镜下解除阻塞的临床成功率为80%（16/20）。在单变量和多变量分析中，仅存在十二指肠支架（比值比 [OR]：3.6，95% 置信区间 [CI] 95%：1.2-10.2；P = 0.018）和胆管厚度小于 15 mm（ OR：3.9，CI 95%：1.3-11.7；P = 0.015）是随访期间胆道梗阻的显着危险因素。结论 随访期间16.3%的患者出现LAMS梗阻，内镜下解除梗阻的有效率为80%。十二指肠支架的存在和胆管厚度小于15毫米是梗阻的危险因素。除这些情况外，在远端恶性梗阻的情况下，可以首先建议使用 EUS-CDS 结合 ECE-LAMS。