Onteddu NKR, Mareddy NSR, Vulasala SSR, Onteddu J, Virarkar M. Revolutionizing palliative care: Electrocautery-enhanced lumen-apposing metal stents in endoscopic-ultrasound-guided biliary drainage for malignant obstructions. World J Gastrointest Surg 2024; 16(7): 2358-2361 [PMID: 39087133 DOI: 10.4240/wjgs.v16.i7.2358]
Corresponding Author of This Article
Sai Swarupa R Vulasala, MD, Doctor, Department of Diagnostic Radiology, University of Florida College of Medicine, 655 West 8th Street, C90, 2nd Floor, Clinical Center, Jacksonville, FL 32209, United States. vulasalaswarupa@gmail.com
Research Domain of This Article
Radiology, Nuclear Medicine & Medical Imaging
Article-Type of This Article
Letter to the Editor
Open-Access Policy of This Article
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/
World J Gastrointest Surg. Jul 27, 2024; 16(7): 2358-2361 Published online Jul 27, 2024. doi: 10.4240/wjgs.v16.i7.2358
Revolutionizing palliative care: Electrocautery-enhanced lumen-apposing metal stents in endoscopic-ultrasound-guided biliary drainage for malignant obstructions
Nirmal Kumar Reddy Onteddu, Naga Sai Rasagna Mareddy, Sai Swarupa R Vulasala, Jayabharath Onteddu, Mayur Virarkar
Nirmal Kumar Reddy Onteddu, Department of Internal Medicine, University of Florida College of Medicine, Jacksonville, FL 32209, United States
Naga Sai Rasagna Mareddy, Department of Diagnostic Radiology, University of Alabama, Birmingham, AL 35294, United States
Sai Swarupa R Vulasala, Mayur Virarkar, Department of Diagnostic Radiology, University of Florida College of Medicine, Jacksonville, FL 32209, United States
Jayabharath Onteddu, Department of Public Health Sciences, University of Florida, Gainesville, FL 32611, United States
Author contributions: Onteddu NKR, Mareddy NSR, Vulasala SSR, Onteddu J, and Virarkar M contributed to this paper; Virarkar M designed the overall concept and outline of the manuscript, and drafted and edited the manuscript; Onteddu NKR, Mareddy NSR, Vulasala SSR, Onteddu J, and Virarkar M contributed to the discussion and design of the manuscript, made critical revision of the manuscript, and the review of literature.
Conflict-of-interest statement: All authors declare no conflicts-of-interest.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Sai Swarupa R Vulasala, MD, Doctor, Department of Diagnostic Radiology, University of Florida College of Medicine, 655 West 8th Street, C90, 2nd Floor, Clinical Center, Jacksonville, FL 32209, United States. vulasalaswarupa@gmail.com
Received: April 3, 2024 Revised: May 29, 2024 Accepted: June 18, 2024 Published online: July 27, 2024 Processing time: 110 Days and 10.6 Hours
Abstract
Patients with malignant biliary obstruction, following endoscopic retrograde cholangiopancreatography (ERCP) failure could be referred for endoscopic-ultrasound-guided biliary drainage through electrocautery-enhanced (ECE) lumen-apposing metal stent (LAMS) placement. However, the efficacy and safety of ECE-LAMS in this scenario have remained debatable due to minimal scientific evidence. The current confirmed 91.0% clinical success, 96.7% technical success, 7.3% reintervention rate, and 17.5% adverse events, following the treatment of malignant biliary obstruction with ECE-LAMS delivery. Finally, ECE-LAMS proved to be a generalizable strategy for managing biliary obstruction for patients who were excluded from ERCP.
Core Tip: The ultrasound-directed electrocautery-enhanced-lumen-apposing metal stent placement is a viable approach for malignant biliary obstruction treatment in patients who do not qualify for endoscopic retrograde cholangiopancreatography (ERCP) or in those with ERCP failure. This finding relies on the acceptable reintervention rate, greater clinical success, and manageable/low adverse events, obtained in the current study.
