Endoscopic ultrasound-guided drainage using lumen-apposing metal stent of malignant afferent limb syndrome in patients with previous Whipple surgery: Multicenter study (with video)

Enrique Pérez-Cuadrado-Robles*, Michiel Bronswijk, Fréderic Prat, Marc Barthet, Maxime Palazzo, Paolo Arcidiacono, Marion Schaefer, Jacques Devière, Roy L. J. van Wanrooij, Ilaria Tarantino, Gianfranco Donatelli, Marine Camus, Andres Sanchez-Yague, Khanh Do-Cong Pham, Jean-Michel Gonzalez, Andrea Anderloni, Juan J. Vila, Julien Jezequel, Alberto Larghi, B. nédicte JaïsEnrique Vazquez-Sequeiros, Pierre H. Deprez, Schalk van der Merwe, Christophe Cellier, Gabriel Rahmi

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


Objectives: 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. Methods: 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. Results: 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. Conclusion: EUS-A is a safe and effective technique in the treatment of malignant ALS, achieving high clinical success with an acceptable recurrence rate.
Original languageEnglish
Pages (from-to)1433-1439
Number of pages7
JournalDigestive endoscopy
Issue number7
Early online date2022
Publication statusPublished - Nov 2022

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