Severe bleeding as a complication of endoscopic choledocho-duodenal drainage using LAMS (Hot-Axios) in the treatment of distal stenosis of the common bile duct due to pancreatic head adenocarcinoma

Czech version

Authors: Belica R. ¹; Kudlová D. ¹; Klepanec A. ²; Hoferica M. ²; Haršany J. ²; Rajec J. ¹; Habiňak M. ¹; Husťak R. ^1,3; Martínek J. ^1,3
Authors‘ workplace: Klinika vnútorného lekárstva FN Trnava, Slovenská republika 2 Rádiologická klinika FN Trnava, Slovenská republika 3 Institut klinické a experimentální medicíny, Praha, Česká republika ¹
Published in: Gastroent Hepatol 2021; 75(3): 207-212
Category: Case Report
doi: https://doi.org/10.48095/ccgh2021207

Overview

Introduction: Endoscopic transpapillary drainage is a common method of solving malignant biliary obstruction. An alternative to the transpapillary approach is endosonographically guided biliary drainage using a lumen-apposition stent, which can be used not only in case of ERCP failure. Case report: We describe our experience with endosonographically guided choledocho-duodenal drainage using a lumen--apposition stent, which was complicated by delayed hemobilia. Persistent and severe bleeding was successfully resolved by endovascular embolization using a spiral coiling. Conclusion: Endosonographically guided drainage using a lumen-apposition stent may, despite all advantages, be accompanied by serious complications, including significant bleeding. Therefore, the availability of an interventional radiology unit is appropriate.

Keywords:

obstructive jaundice – endoscopic retrograde cholangiopancreatography – Adenocarcinoma – Pancreas – cholestasis –endosonography

Sources

1. Dumonceau JM, Tringali A, Papanikolaou IS et al. Endoscopic biliary stenting: indications, choice of stents, and results: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline –⁠ Updated October 2017. Endoscopy 2018; 50(9): 910–930. doi:10.1055/ a-0659-9864.

2. Mussetto A, Fugazza A, Fuccio L et al. Current uses and outcomes of lumen-apposing metal stents. Ann Gastroenterol 2018; 31(5): 535–540. doi:10.20524/ aog.2018.0287.

3. Bang JY, Navaneethan U, Hasan M et al. Stent placement by EUS or ERCP for primary biliary decompression in pancreatic cancer: a randomized trial (with videos). Gastrointest Endosc 2018; 88(1): 9–17. doi:10.1016/ j.gie.2018.03.012.

4. Brountzos EN, Ptochis N, Panagiotou I et al. A survival analysis of patients with malignant biliary strictures treated by percutaneous metallic stenting. Cardiovasc Intervent Radiol 2007; 30(1): 66–73. doi:10.1007/ s00270-005-0379-3.

5. Pedersoli F, Schröder A, Zimmermann M et al. Percutaneous transhepatic biliary drainage (PTBD) in patients with dilated vs. nondilated bile ducts: technical considerations and complications. Eur Radiol 2021; 31(5): 3035–3041. doi:10.1007/ s00330-020-07368-6.

6. Tsuchiya T, Teoh AYB, Itoi T et al. Long-term outcomes of EUS-guided choledochoduodenostomy using a lumen-apposing metal stent for malignant distal biliary obstruction: a prospective multicenter study. Gastrointest Endosc 2018; 87(4): 1138–1146. doi:10.1016/ j.gie.2017.08.017.

7. Leung Ki EL, Napoleon B. Endoscopic ultrasound-guided biliary drainage: A change in paradigm? World J Gastrointest Endosc 2019; 11(5): 345–353. doi:10.4253/ wjge.v11.i5.345.

8. Papadopoulos P, Bize P, Guiu B et al. Percutaneous transhepatic stent graft placement for treatment of hepatic artery injury after a Whipple procedure. J Vasc Interv Radiol 2014; 25(6): 977–978. doi:10.1016/ j.jvir.2014.03.020.

9. Hathorn KE, Bazarbashi AN, Sack JS et al. EUS-guided biliary drainage is equivalent to ERCP for primary treatment of malignant distal biliary obstruction: a systematic review and meta-analysis. Endosc Int Open 2019; 7(11): E1432–E1441. doi:10.1055/ a-0990-9488.

10. Leung Ki EL, Napoleon B. Endoscopic ultrasound-guided biliary drainage: A change in paradigm? World J Gastrointest Endosc 2019; 11(5): 345–353. doi:10.4253/ wjge.v11.i5.345.

11. Papadopoulos P, Bize P, Guiu B et al. Percutaneous transhepatic stent graft placement for treatment of hepatic artery injury after a Whipple procedure. J Vasc Interv Radiol 2014; 25(6): 977–978. doi:10.1016/ j.jvir.2014.03.020.

12. Hathorn KE, Bazarbashi AN, Sack JS et al. EUS-guided biliary drainage is equivalent to ERCP for primary treatment of malignant distal biliary obstruction: a systematic review and meta-analysis. Endosc Int Open 2019; 7(11): E1432–E1441. doi:10.1055/ a-0990-9488.