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Background: It is unclear whether preoperative biliary drainage (PBD) by endoscopic retrograde cholangiopancreatography (ERCP) is equivalent to electrocautery-enhanced lumen-apposing metal stent (ECE-LAMS) before pancreatoduodenectomy (PD).

Methods: Patients who underwent PBD for distal malignant biliary obstruction (DMBO) followed by PD were retrospectively included in nine expert centers between 2015 and 2022. ERCP or endoscopic ultrasound-guided choledochoduodenostomy with ECE-LAMS were performed. In intent-to-treat analysis, patients drained with ECE-LAMS were considered the study group (first-LAMS group) and those drained with conventional transpapillary stent the control group (first-cannulation group). The rates of technical success, clinical success, drainage-related complications, surgical complications, and oncological outcomes were analyzed.

Results: Among 156 patients, 128 underwent ERCP and 28 ECE-LAMS in first intent. The technical and clinical success rates were 83.5% and 70.2% in the first-cannulation group versus 100% and 89.3% in the first-LAMS group (p = 0.02 and p = 0.05, respectively). The overall complication rate over the entire patient journey was 93.7% in first-cannulation group versus 92.0% in first-LAMS group (p = 0.04). The overall endoscopic complication rate was 30.5% in first-cannulation group versus 17.9% in first-LAMS group (p = 0.25). The overall complication rate after PD was higher in the first-cannulation group than in the first-LAMS group (92.2% versus 75.0%, p = 0.016). Overall survival and progression-free survival did not differ between the groups.

Conclusions: PBD with ECE-LAMS is easier to deploy and more efficient than ERCP in patients with DMBO. It is associated with less surgical complications after pancreatoduodenectomy without compromising the oncological outcome.

Titel:	Pancreatoduodenectomy Following Preoperative Biliary Drainage Using Endoscopic Ultrasound-Guided Choledochoduodenostomy Versus a Transpapillary Stent: A Multicenter Comparative Cohort Study of the ACHBT-FRENCH-SFED Intergroup.
Autor/in / Beteiligte Person:	Janet, J ; Albouys, J ; Napoleon, B ; Jacques, J ; Mathonnet, M ; Magne, J ; Fontaine, M ; de Ponthaud C ; Durand Fontanier, S ; Bardet, SSM ; Bourdariat, R ; Sulpice, L ; Lesurtel, M ; Legros, R ; Truant, S ; Robin, F ; Prat, F ; Palazzo, M ; Schwarz, L ; Buc, E ; Sauvanet, A ; Gaujoux, S ; Taibi, A
Link:	View record at Springer (Volltext)
Zeitschrift:	Annals of surgical oncology, Jg. 30 (2023-08-01), Heft 8, S. 5036-5046
Veröffentlichung:	2005- : New York, NY : Springer ; <i>Original Publication</i>: New York, NY : Raven Press, c1994-, 2023
Medientyp:	academicJournal
ISSN:	1534-4681 (electronic)
DOI:	10.1245/s10434-023-13466-8
Schlagwort:	Humans Pancreaticoduodenectomy adverse effects Cohort Studies Retrospective Studies Stents adverse effects Endosonography Cholangiopancreatography, Endoscopic Retrograde adverse effects Drainage adverse effects Ultrasonography, Interventional Choledochostomy adverse effects Cholestasis etiology Cholestasis surgery
Sonstiges:	Nachgewiesen in: MEDLINE Sprachen: English Publication Type: Multicenter Study; Journal Article Language: English [Ann Surg Oncol] 2023 Aug; Vol. 30 (8), pp. 5036-5046. <i>Date of Electronic Publication: </i>2023 Apr 17. MeSH Terms: Choledochostomy* / adverse effects ; Cholestasis* / etiology ; Cholestasis* / surgery ; Humans ; Pancreaticoduodenectomy / adverse effects ; Cohort Studies ; Retrospective Studies ; Stents / adverse effects ; Endosonography ; Cholangiopancreatography, Endoscopic Retrograde / adverse effects ; Drainage / adverse effects ; Ultrasonography, Interventional References: Tol JAMG, van Hooft JE, Timmer R, et al. Metal or plastic stents for preoperative biliary drainage in resectable pancreatic cancer. Gut. 2016;65(12):1981–7. https://doi.org/10.1136/gutjnl-2014-308762 . (PMID: 10.1136/gutjnl-2014-30876226306760) ; Watanabe J, Miki A, Sasanuma H, Kotani K, Sata N. 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Pancreatoduodenectomy Following Preoperative Biliary Drainage Using Endoscopic Ultrasound-Guided Choledochoduodenostomy Versus a Transpapillary Stent: A Multicenter Comparative Cohort Study of the ACHBT-FRENCH-SFED Intergroup.