Opinion Review
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Aug 7, 2019; 25(29): 3857-3869
Published online Aug 7, 2019. doi: 10.3748/wjg.v25.i29.3857
Lumen-apposing metal stents for malignant biliary obstruction: Is this the ultimate horizon of our experience?
Andrea Anderloni, Edoardo Troncone, Alessandro Fugazza, Annalisa Cappello, Giovanna Del Vecchio Blanco, Giovanni Monteleone, Alessandro Repici
Andrea Anderloni, Alessandro Fugazza, Annalisa Cappello, Alessandro Repici, Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Research Hospital, Milan 20089, Italy
Edoardo Troncone, Giovanna Del Vecchio Blanco, Giovanni Monteleone, Department of Systems Medicine, University of Rome “Tor Vergata”, Rome 00133, Italy
Alessandro Repici, Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas University, Milan 20089, Italy
Author contributions: Anderloni A, Troncone E and Fugazza A designed the study; Troncone E and Fugazza A wrote the paper; Del Vecchio Blanco G, Monteleone G and Cappello A critical revision of the work; Anderloni A and Repici A supervised the work.
Conflict-of-interest statement: Dr. Anderloni reports personal fees from Boston Scientific, during the conduct of the study; personal fees from Boston Scientific, outside the submitted work; Dr. Repici reports personal fees from Boston Scientific, personal fees from Fujifilm, during the conduct of the study; personal fees from Boston Scientific, personal fees from Fujifilm, outside the submitted work; Dr. Troncone, Dr. Fugazza, Dr. Del Vecchio Blanco, Dr. Cappello, Dr. Monteleone have nothing to disclose.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Andrea Anderloni, MD, PhD, Chief Doctor, Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Research Hospital, Via Manzoni 56, Milan 20089, Italy. andrea.anderloni@humanitas.it
Telephone: +39-02-82247308
Received: March 2, 2019
Peer-review started: March 3, 2019
First decision: April 30, 2019
Revised: June 20, 2019
Accepted: July 1, 2019
Article in press: July 3, 2019
Published online: August 7, 2019
Processing time: 158 Days and 13.3 Hours
Abstract

In the last years, endoscopic ultrasonography (EUS) has evolved from a purely diagnostic technique to a more and more complex interventional procedure, with the possibility to perform several type of therapeutic interventions. Among these, EUS-guided biliary drainage (BD) is gaining popularity as a therapeutic approach after failed endoscopic retrograde cholangiopancreatography in distal malignant biliary obstruction (MBO), due to the avoidance of external drainage, a lower rate of adverse events and re-interventions, and lower costs compared to percutaneous trans-hepatic BD. Initially, devices created for luminal procedures (e.g., luminal biliary stents) have been adapted to the new trans-luminal EUS-guided interventions, with predictable shortcomings in technical success, outcome and adverse events. More recently, new metal stents specifically designed for transluminal drainage, namely lumen-apposing metal stents (LAMS), have been made available for EUS-guided procedures. An electrocautery enhanced delivery system (EC-LAMS), which allows direct access of the delivery system to the target lumen, has subsequently simplified the classic multi-step procedure of EUS-guided drainages. EUS-BD using LAMS and EC-LAMS has been demonstrated effective and safe, and currently seems one of the most performing techniques for EUS-BD. In this Review, we summarize the evolution of the EUS-BD in distal MBO, focusing on the novelty of LAMS and analyzing the unresolved questions about the possible role of EUS as the first therapeutic option to achieve BD in this setting of patients.

Keywords: Interventional endoscopic ultrasonography; Endoscopic ultrasonography-guided biliary drainage; Endoscopic ultrasonography-guided choledocho-duodenostomy; Biliary metal stent; Lumen-apposing metal stent

Core tip: Endoscopic ultrasonography (EUS)-guided choledocho-duodenostomy represents one of the possible therapeutic options to achieve biliary drainage after failed endoscopic retrograde cholangiopancreatography. Lumen-apposing metal stent (LAMS) are fully covered metal stents specifically designed for EUS-guided transluminal interventions, such as peripancreatic fluid collection or gallbladder drainage, that have been proposed for biliary drainage in the setting of distal malignant biliary obstruction, in order to overcome the limits of non-dedicated devices. This Review focuses on the new role of LAMS in the complex scenario of EUS-guided biliary drainage.