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Publications

Journal Article Consensus Statement Ppublish

PubMed: 42613856 DOI: 10.1002/ueg2.70267

EUS-Guided Choledochoduodenostomy With Lumen-Apposing Metal Stents: A Recommendation From an Expert Delphi Consensus.

United European Gastroenterol J 14(7):e70267

Authors: Tawfik Khoury, Wisam Sbeit, Pietro Fusaroli, Khanh Do-Cong Pham, Michiel Bronswijk, Benedetto Mangiavillano, Sarah Leblanc, Sundeep Lakhtakia, Jeremie Jacques, Carlos Robles-Medranda, Anthony Yuen Bun Teoh, Giuseppe Vanella, Rares Ilie Orzan, Marco Spadaccini, Ilaria Tarantino, Andrea Anderloni, Cesare Hassan, Peter Siersema, Michel Kahaleh, Carlo Fabbri, Cecilia Binda, M Perez-Miranda, R L J van Wanrooij, Fabien Fumex, Rodica Gincul, Antonio Facciorusso, Schalk Van der Merwe, Paolo Giorgio Arcidiacono, Rastislav Kunda, Stefano Francesco Crinò, Pierre H Deprez, Andrea Lisotti, Bertrand Napoléon

Affiliations

  • Department of Gastroenterology, Galilee Medical Center, Nahariya, Israel.
  • Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel.
  • Gastroenterology Unit, University of Bologna, Hospital of Imola, Imola, Italy.
  • Section of Gastroenterology, Department of Medicine, Haukeland University Hospital, Bergen, Norway.
  • Gastroenterology and Hepatology, KU Leuven University Hospitals Leuven, Leuven, Belgium.
  • Gastroenterology and Hepatology, Imelda Hospital, Bonheiden, Belgium.
  • Gastrointestinal Endoscopy Unit, Humanitas Mater Domini, Castellanza, (VA), Italy.
  • Division of Gastroenterology and Digestive Endoscopy, Humanitas Research Hospital-IRCCS, Rozzano, Italy.
  • Digestive Endoscopy Unit, Hôpital Privé Jean Mermoz, Ramsay Sante, Lyon, France.
  • Asian Institute of Gastroenterology, Hyderabad, India.
  • Gastroenterology and Endoscopy, CHU Limoges, Limoges, France.
  • Gastroenterology and Endoscopy Division, Instituto Ecuatoriano de Enfermedades Digestivas, University Hospital Omni, Guayaquil, Ecuador.
  • Surgery, Prince of Wales Hospital, Hong Kong, Hong Kong.
  • Pancreatobiliary Endoscopy and Endosonography, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy.
  • Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca, Romania.
  • IRCCS Humanitas Research Hospital and Humanitas University, Rozzano, Italy.
  • Gastroenterology and Endoscopy Unit, Istituto Mediterraneo per i Trapianti e Terapie di alta Specializzazione-IRCCS ISMETT, Palermo, Italy.
  • Department of Internal Medicine and Medical Therapeutics, University of Pavia, Pavia, Italy.
  • Gastroenterology and Digestive Endoscopy Unit, Fondazione I.R.C.C.S. Policlinico San Matteo, Pavia, Italy.
  • Endoscopy Unit, Gastroenterology Department, Humanitas Research Hospital IRCCS, Pavia, Italy.
  • Department of Biomedical Sciences, Humanitas University, Milan, Italy.
  • Gastroenterology and Hepatology, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands.
  • Advanced and Therapeutic Endoscopy, Hackensack University Medical Center, Hackensack, New Jersey, USA.
  • Gastroenterology and Digestive Endoscopy Unit, Forlì-Cesena Hospitals, AUSL Romagna, Ravenna, Italy.
  • Gastroenterology Department, University Hospital Rio Hortega, Valladolid Health Research Institute (IBioVALL), Valladolid, Spain.
  • Gastroenterology and Hepatology, Amsterdam UMC, Location Vrije University, Amsterdam, the Netherlands.
  • Gastroenterology Unit, Department of Experimental Medicine, University of Salento, Lecce, Italy.
  • Gastroenterology & Hepatology, National University of Singapore and National University Hospital, Singapore City, Singapore.
  • Department of Medicine, University of Verona, Verona, Italy.
  • Department of Gastroenterology & Hepatology, Université Catholique de Louvain, Cliniques Universitaires Saint-Luc, Brussels, Belgium.

Abstract

BACKGROUND AND AIMS

Endoscopic ultrasound-guided choledochoduodenostomy with a lumen apposing metal stent (EUS-CDS-L) is an increasingly utilized therapeutic option for biliary drainage. However, numerous procedural and periprocedural factors may influence technical and clinical outcomes. The aim of this study was to develop an expert consensus on key recommendations for EUS-CDS-L.

METHODS

Thirty-two international experts in EUS-CDS-L contributed to this Delphi process over two rounds by voting anonymously on 28 statements using a five-point Likert scale. Statements were accepted in the first round or revised in the second round based on an agreement level of ≥ 80%, with a median ≥ 4, and an interquartile range (IQR) ≤ 1.

RESULTS

28 statements were initially circulated, 2 were removed, and 26 were considered for final consensus. A consensus was achieved for 24 of 26 (92.3%) statements after two voting rounds across the three domains, with the first focusing on indications: (1) the preference for EUS-CDS-L in distal malignant biliary obstruction (DMBO) without gastric outlet obstruction (GOO); (2) the inclusion of EUS-CDS-L as a therapeutic option in benign biliary obstruction, and (3) the performance of EUS-CDS-L in patients scheduled for upfront surgery. A second domain focused on procedural considerations: (1) the preferred cutoff of common bile duct (CBD) diameter for safe EUS-CDS-L, and (2) the lack of evidence for antibiotic prophylaxis, and several technical steps in the recommended deployment process.

CONCLUSION

This modified Delphi consensus provides international expert panel agreement on several key aspects of EUS-CDS-L, while also highlighting areas that require further research.

MeSH

Stents, Therapeutics, Gastrointestinal Diseases