THROUGH-THE-LAMS RETROGRADE ACCESS ERCP (TRAE) IN PATIENTS WITH NATIVE UPPER GI ANASTOMY: A NOVEL ENDOSCOPIC APPROACH FOR COMBINED BILIARY AND GASTRIC-OUTLET OBSTRUCTION (CBGO)
DDW ePoster Library. Cobreros del Caz M. 05/02/26; 4206283; Sp191
RESERVED CONTENT
This content is reserved for meeting participants.
Simply log in using your Badge ID and Last Name as your credentials.
Not registered?
Click here to register.
If you have trouble accessing the content, please contact support@multilearning.com or use the chat widget.
Abstract
Discussion Forum (0)
Biliary drainage in patients with CBGO (benign or malignant). Anterograde transpyloric access to the papilla for ERCP is difficult in the most common type I/II stenosis. Extrahepatic EUS-guided biliary drainage (EUS-BD) achieves suboptimal outocomes in the setting of CBGO, whereas intrahepatic EUS-BD is limited by lack of intrahepatic dilation and by ascites. To solve this problem, we propose TRAE (Through-the-LAMS Retrograde Access ERCP). This approach adapts the concept of through-the-LAMS ERCP, currently widely used in patients with post-surgical anatomy, to patients with native anatomy and CBGO. To circumvent antegrade blockage preventing access to the papilla, EUS-guided gastroenterostomy (EUS-GE) with a lumen-apposing metal stent (LAMS) is first performed. Once EUS-GE is established, a duodenoscope or a therapeutic forward viewing upper endoscope is passed through-the-LAMS to access the papilla. We evaluated the safety and efficacy of TRAE for biliary drainage in non-surgical patients with native anatomy and CBGO.
Results: A descriptive multicenter study was undertaken. Nineteen patients (71% male; age: 69 [62-83]) from seven hospitals were retrospectively identified with 26 attempts at TRAE between 1/1/20 and 26/6/25. Definitions: index procedure (first successful attempt or definitive ERCP failure) or follow-up procedure. Technical success (TS): cannulation/intervention by ERCP. Clinical success (CS): resolution of cholangitis/jaundice. Baseline clinical data and technique modifications were recorded.
There were 26 TRAEs (19 index/6 scheduled revisions/1 failed prior to index TRAE) in 19 patients. TS/patient during index TRAE was 13/19 (68.5%); one failed TRAE was salvaged at on a repeat attempt using double guidewire traction, following antergrade transpyloric rendezvous, with guidewire retrieval towards the EUS-GE through the LAMS. TS/procedure = 19/26 (73%), with 6 failed TRAE salvaged by EUS-BD. Failed TRAE incidence: 5 (70%) without papillary access, and 2 without cannulation. TS in follow-up TRAE was 6/6 (100%). CS was obtained in 100% of patients/procedures with TS.
Biliary stent carriers and patients with prior GOO treated with LAMS predominated (Table). AE: 2 LAMS dislodgement (7.7%), one required surgery and another underwent laparotomy despite successful salvage and died of postoperative AEs. Dual guidewire traction effectively prevented LAMS dislodgment (0/13 vs 2/13). During follow-up, 2 transpapillary stent dysfunctions (15%), required convertion to EUS-BD.
TRAE allows biliary drainage in anatomically challenging patient with native upper GI anatomy and CBGO, it is facilitated by a therapeutic gastroscope with dual guidewire traction, and is particularly suited for nonsurgical patients requiring revisions. This novel approach appears to avoid less invasive therapeutic options
Results: A descriptive multicenter study was undertaken. Nineteen patients (71% male; age: 69 [62-83]) from seven hospitals were retrospectively identified with 26 attempts at TRAE between 1/1/20 and 26/6/25. Definitions: index procedure (first successful attempt or definitive ERCP failure) or follow-up procedure. Technical success (TS): cannulation/intervention by ERCP. Clinical success (CS): resolution of cholangitis/jaundice. Baseline clinical data and technique modifications were recorded.
There were 26 TRAEs (19 index/6 scheduled revisions/1 failed prior to index TRAE) in 19 patients. TS/patient during index TRAE was 13/19 (68.5%); one failed TRAE was salvaged at on a repeat attempt using double guidewire traction, following antergrade transpyloric rendezvous, with guidewire retrieval towards the EUS-GE through the LAMS. TS/procedure = 19/26 (73%), with 6 failed TRAE salvaged by EUS-BD. Failed TRAE incidence: 5 (70%) without papillary access, and 2 without cannulation. TS in follow-up TRAE was 6/6 (100%). CS was obtained in 100% of patients/procedures with TS.
Biliary stent carriers and patients with prior GOO treated with LAMS predominated (Table). AE: 2 LAMS dislodgement (7.7%), one required surgery and another underwent laparotomy despite successful salvage and died of postoperative AEs. Dual guidewire traction effectively prevented LAMS dislodgment (0/13 vs 2/13). During follow-up, 2 transpapillary stent dysfunctions (15%), required convertion to EUS-BD.
TRAE allows biliary drainage in anatomically challenging patient with native upper GI anatomy and CBGO, it is facilitated by a therapeutic gastroscope with dual guidewire traction, and is particularly suited for nonsurgical patients requiring revisions. This novel approach appears to avoid less invasive therapeutic options
Biliary drainage in patients with CBGO (benign or malignant). Anterograde transpyloric access to the papilla for ERCP is difficult in the most common type I/II stenosis. Extrahepatic EUS-guided biliary drainage (EUS-BD) achieves suboptimal outocomes in the setting of CBGO, whereas intrahepatic EUS-BD is limited by lack of intrahepatic dilation and by ascites. To solve this problem, we propose TRAE (Through-the-LAMS Retrograde Access ERCP). This approach adapts the concept of through-the-LAMS ERCP, currently widely used in patients with post-surgical anatomy, to patients with native anatomy and CBGO. To circumvent antegrade blockage preventing access to the papilla, EUS-guided gastroenterostomy (EUS-GE) with a lumen-apposing metal stent (LAMS) is first performed. Once EUS-GE is established, a duodenoscope or a therapeutic forward viewing upper endoscope is passed through-the-LAMS to access the papilla. We evaluated the safety and efficacy of TRAE for biliary drainage in non-surgical patients with native anatomy and CBGO.
Results: A descriptive multicenter study was undertaken. Nineteen patients (71% male; age: 69 [62-83]) from seven hospitals were retrospectively identified with 26 attempts at TRAE between 1/1/20 and 26/6/25. Definitions: index procedure (first successful attempt or definitive ERCP failure) or follow-up procedure. Technical success (TS): cannulation/intervention by ERCP. Clinical success (CS): resolution of cholangitis/jaundice. Baseline clinical data and technique modifications were recorded.
There were 26 TRAEs (19 index/6 scheduled revisions/1 failed prior to index TRAE) in 19 patients. TS/patient during index TRAE was 13/19 (68.5%); one failed TRAE was salvaged at on a repeat attempt using double guidewire traction, following antergrade transpyloric rendezvous, with guidewire retrieval towards the EUS-GE through the LAMS. TS/procedure = 19/26 (73%), with 6 failed TRAE salvaged by EUS-BD. Failed TRAE incidence: 5 (70%) without papillary access, and 2 without cannulation. TS in follow-up TRAE was 6/6 (100%). CS was obtained in 100% of patients/procedures with TS.
Biliary stent carriers and patients with prior GOO treated with LAMS predominated (Table). AE: 2 LAMS dislodgement (7.7%), one required surgery and another underwent laparotomy despite successful salvage and died of postoperative AEs. Dual guidewire traction effectively prevented LAMS dislodgment (0/13 vs 2/13). During follow-up, 2 transpapillary stent dysfunctions (15%), required convertion to EUS-BD.
TRAE allows biliary drainage in anatomically challenging patient with native upper GI anatomy and CBGO, it is facilitated by a therapeutic gastroscope with dual guidewire traction, and is particularly suited for nonsurgical patients requiring revisions. This novel approach appears to avoid less invasive therapeutic options
Results: A descriptive multicenter study was undertaken. Nineteen patients (71% male; age: 69 [62-83]) from seven hospitals were retrospectively identified with 26 attempts at TRAE between 1/1/20 and 26/6/25. Definitions: index procedure (first successful attempt or definitive ERCP failure) or follow-up procedure. Technical success (TS): cannulation/intervention by ERCP. Clinical success (CS): resolution of cholangitis/jaundice. Baseline clinical data and technique modifications were recorded.
There were 26 TRAEs (19 index/6 scheduled revisions/1 failed prior to index TRAE) in 19 patients. TS/patient during index TRAE was 13/19 (68.5%); one failed TRAE was salvaged at on a repeat attempt using double guidewire traction, following antergrade transpyloric rendezvous, with guidewire retrieval towards the EUS-GE through the LAMS. TS/procedure = 19/26 (73%), with 6 failed TRAE salvaged by EUS-BD. Failed TRAE incidence: 5 (70%) without papillary access, and 2 without cannulation. TS in follow-up TRAE was 6/6 (100%). CS was obtained in 100% of patients/procedures with TS.
Biliary stent carriers and patients with prior GOO treated with LAMS predominated (Table). AE: 2 LAMS dislodgement (7.7%), one required surgery and another underwent laparotomy despite successful salvage and died of postoperative AEs. Dual guidewire traction effectively prevented LAMS dislodgment (0/13 vs 2/13). During follow-up, 2 transpapillary stent dysfunctions (15%), required convertion to EUS-BD.
TRAE allows biliary drainage in anatomically challenging patient with native upper GI anatomy and CBGO, it is facilitated by a therapeutic gastroscope with dual guidewire traction, and is particularly suited for nonsurgical patients requiring revisions. This novel approach appears to avoid less invasive therapeutic options
Code of conduct/disclaimer available in General Terms & Conditions
{{ help_message }}
{{filter}}