Assessment of EUS-Guided Biliary Drainage With Lumen-Apposing Metal Stents

This study evaluated the safety, feasibility, and QoL of patients after endoscopic ultrasonography-guided biliary drainage with lumen-apposing metal stents, after failed ERCP.

Endoscopic ultrasonography-guided biliary drainage (EUS-BD) using Lumen-Apposing Metal Stents (LAMSs) is technically successful, safe, and a feasible treatment for inoperable malignant distal common bile duct (CBD) strictures, according to the results of a study published in Gastrointestinal Endoscopy.

A group of investigators from the National Institutes of Health Research Nottingham Biomedical Research Center conducted a multicenter prospective study to determine the safety, feasibility, and quality of life of patients after EUS-BD with LAMSs, after failed endoscopic retrograde cholangio-pancreatography (ERCP).

The primary outcome was to assess the feasibility and technical success of LAMS placement in EUS-BD of inoperable malignant distal CBD obstruction. The secondary outcome included assessment of clinical success (>50% improvement at day 7 or bilirubin <50 at day 30), procedure-related adverse events, QOL before as well as after EUS-BD (European Organization for Research and Treatment of Cancer 21-item quality of life questionnaire for biliary tract cancer), and 30-day mortality.

Endoscopic ultrasonography-guided biliary drainage was technically successful for all 20 patients included in the study, with clinical success of 95% (19/20) at day 7 (>50% reduction in bilirubin) and 92.3% (12/13) at day 30 (bilirubin <2.92mg/dL). The researchers found significant improvements in overall quality of life score (49 vs 42; P =.03) at day 30. In addition, all cause 30 day-mortality was 20%, and the moderate adverse event rate was 10% (1 cholangitis and 1 stent migration).

This study had several limitations, including its relatively small size study population, lack of a percutaneous transhepatic biliary drainage control arm, and patients undergoing EUS-BD after failed ERCP may not be generalizable throughout the United Kingdom.

The authors concluded, “LAMSs can be used safely and effectively for EUS-BD in patients with inoperable malignant distal biliary obstruction where ERCP failed to achieve biliary drainage.”

Disclosure: Multiple authors declared affiliations with industry. Please refer to the original article for a full list of authors’ disclosures.


Venkatachalapathy SV, James MW, Huggest M, et al. Utility of palliative EUS-guided biliary drainage using lumen-apposing metal stents: a prospective multicenter feasibility study (with video). Gastrointestinal Endoscopy. Published online February 2, 2021.