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Cancers
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Palliation of Gastrointestinal Tumors with Lumen Apposing Metal Stents
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Palliation of Gastrointestinal Tumors with Lumen Apposing Metal Stents

A special issue of Cancers (ISSN 2072-6694).

Deadline for manuscript submissions: closed (31 March 2023) | Viewed by 12421

Special Issue Editors

Dr. Antonio Facciorusso

E-Mail Website
Guest Editor
Department of Medical and Surgical Sciences, Endoscopy Unit, University of Foggia, Foggia, Italy
Interests: gastrointestinal endoscopy; endoscopic ultrasound; liver cancer; pancreatology
Special Issues, Collections and Topics in MDPI journals
Prof. Dr. Benedetto Mangiavillano

E-Mail Website
Guest Editor
Gastrointestinal Endoscopy Unit, Humanitas Mater Domini, Via Gerenzano 2, 21053 Castellanza, Italy
Interests: gastrointestinal endoscopy; endoscopic ultrasound; ERCP; pancreatology

Special Issue Information

Dear Colleagues,

Endoscopic stents are designed to prevent constriction or collapse of a tubular portion of gastrointestinal (GI) tract and currently used in management of variety of diseases of the esophagus, stomach, small bowel, colon, and bilio-pancreatic system. Common indications of endoscopic stents include reestablishment or maintenance of luminal patency in cases of malignant obstruction, as well as sealing transmural defects and diverting luminal contents in leaks, fistulae, or perforations. Other indication is to determine a bypass able to drive the luminal content downstream a malignant obstruction. Recently lumen-apposing metal stents (LAMS) determined a paradigm shift in the scenario of endoscopic palliation of GI malignant tumors thanks to their large diameter and the easy procedure. 

Aim of this Special issue is to collect the recent cutting-edge evidence on the use and application of LAMS in the field and to provide an overview on the clinical and technical results achieved with these newer devices. The topic of this special issue is focused specifically on the palliation of malignant GI conditions, such as duodenal stenosis due to pancreatic adenocarcinoma, malignant gastric outlet syndrome, malignant biliary obstruction, gallbladder carcinoma but also on the recent applications in lower GI tumors.

We look forward to receiving your contributions.

Prof. Dr. Antonio Facciorusso
Prof. Dr. Benedetto Mangiavillano
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Cancers is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • pancreas
  • LAMS
  • EUS
  • endoscopic ultrasound
  • endoscopy
  • cancer

Published Papers (6 papers)

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Research

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10 pages, 1911 KiB  
Article
EUS-Guided Gastroenterostomy in Malignant Gastric Outlet Obstruction: A Comparative Study between First- and Second-Line Approaches after Enteral Stent Placement
by Enrique Perez-Cuadrado-Robles, Hadrien Alric, Ali Aidibi, Michiel Bronswijk, Giuseppe Vanella, Claire Gallois, Hedi Benosman, Emilia Ragot, Claire Rives-Lange, Gabriel Rahmi and Christophe Cellier
Cancers 2022, 14(22), 5516; https://doi.org/10.3390/cancers14225516 - 10 Nov 2022
Cited by 5 | Viewed by 2213
Abstract
Introduction: Endoscopic ultrasound-guided gastroenterostomy (EUS-GE) is increasingly used in the setting of malignant gastric outlet obstruction (GOO). However, little is known about the role of primary EUS-GE. The aim of the present study is to compare the outcomes of EUS-GE by using the [...] Read more.
Introduction: Endoscopic ultrasound-guided gastroenterostomy (EUS-GE) is increasingly used in the setting of malignant gastric outlet obstruction (GOO). However, little is known about the role of primary EUS-GE. The aim of the present study is to compare the outcomes of EUS-GE by using the freehand technique as a first- and second-line approach after enteral stenting (ES). Methods: This is an observational single-center study using a prospectively collected database. All consecutive patients who underwent an EUS-GE using the freehand technique due to malignant GOO were included. Patients with previous gastric surgery, a wire-guided EUS-GE technique, or those presenting without GOO were excluded. The primary outcome was the clinical success, defined as a solid oral intake at 1 week after the procedure (GOO Score, GOOSS ≥ 2). The secondary outcomes were technical success and adverse event (AE) rates. The impact on nutritional parameters was also assessed. Results: Forty-five patients underwent an EUS-GE for all indications. Finally, 28 patients (mean age: 63 ± 17.2 years, 57.1% male) with (n = 13, 46.4%) and without (n = 15, 53.6%) a previous ES were included. The technical success was achieved in 25 cases (89.3%), with no differences between the two groups (92.3% vs. 86.7%, p = 1). The median limb diameter and procedure time were 27 mm (range:15–48) and 37 min. Overall, clinical success was achieved in 22 cases (88%), with three failures due to AEs (n = 2) or peritoneal carcinomatosis (n = 1). The diet progression was quicker in patients with a previous ES (GOOSS at 48 h, 2 vs. 1, p = 0.023), but the GOOSS at 1 week (p = 0.299), albumin gain (p = 0.366), and BMI gain (0.257) were comparable in the two groups. The AE rate was 7.1%. Conclusions: EUS-GE achieves a high technical and clinical success in patients with GOO regardless of the presence of a previous ES. Patients with previous ES may have a quicker progression of their diet, but the GOOSS and nutritional status in the long term at 1 week or 1 month are comparable. Primary EUS-GE might require fewer procedures and less discontinuation of chemotherapy to achieve a comparable result. Full article
(This article belongs to the Special Issue Palliation of Gastrointestinal Tumors with Lumen Apposing Metal Stents)
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Review

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11 pages, 1200 KiB  
Review
Endoscopic Ultrasound-Guided Gallbladder Drainage for Malignant Biliary Obstruction: A Systematic Review
by Padraic McDonagh, Bidour Awadelkarim, John S. Leeds, Manu K. Nayar and Kofi W. Oppong
Cancers 2023, 15(11), 2988; https://doi.org/10.3390/cancers15112988 - 30 May 2023
Cited by 1 | Viewed by 1337
Abstract
Background: Endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) is a rescue technique for patients with malignant biliary obstruction who fail conventional treatment with ERCP or EUS-guided biliary drainage. The technique has been successfully employed in the management of acute cholecystitis in patients not fit for [...] Read more.
Background: Endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) is a rescue technique for patients with malignant biliary obstruction who fail conventional treatment with ERCP or EUS-guided biliary drainage. The technique has been successfully employed in the management of acute cholecystitis in patients not fit for surgery. However, the evidence for its use in malignant obstruction is less robust. This review article aims to evaluate the data available at present to better understand the safety and efficacy of EUS-guided gallbladder drainage. Methods: A detailed literature review was conducted and several databases were searched for any studies relating to EUS-GBD in malignant biliary obstruction. Pooled rates with 95% confidence intervals were calculated for clinical success and adverse events. Results: Our search identified 298 studies related to EUS-GBD. The final analysis included 7 studies with 136 patients. The pooled rate of clinical success (95% CI) was 85% (78–90%, I2: 0%). The pooled rate of adverse events (95% CI) was 13% (7–19%, I2: 0%). Adverse events included: peritonitis, bleeding, bile leakage, stent migration, and stent occlusion. No deaths directly related to the procedure were reported; however, in some of the studies, deaths occurred due to disease progression. Conclusion: This review supports the use of EUS-guided gallbladder drainage as a rescue option for patients who have failed conventional measures. Full article
(This article belongs to the Special Issue Palliation of Gastrointestinal Tumors with Lumen Apposing Metal Stents)
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10 pages, 1263 KiB  
Review
The Role of Lumen Apposing Metal Stents in the Palliation of Distal Malignant Biliary Distal Obstruction
by Theodor Alexandru Voiosu, Mihai Rimbaș and Alberto Larghi
Cancers 2023, 15(10), 2730; https://doi.org/10.3390/cancers15102730 - 12 May 2023
Cited by 1 | Viewed by 1060
Abstract
Malignant biliary obstruction (DMBO) has been traditionally managed by endoscopic retrograde cholangiopancreatography (ERCP). In the case of ERC failure, percutaneous transhepatic biliary drainage (PT-BD) has been widely utilized as a salvage procedure. However, over the last decade, endoscopic ultrasound-guided biliary drainage (EUS-BD) has [...] Read more.
Malignant biliary obstruction (DMBO) has been traditionally managed by endoscopic retrograde cholangiopancreatography (ERCP). In the case of ERC failure, percutaneous transhepatic biliary drainage (PT-BD) has been widely utilized as a salvage procedure. However, over the last decade, endoscopic ultrasound-guided biliary drainage (EUS-BD) has gained increasing popularity, especially after the advent of electrocautery-enhanced lumen apposing metal stent devices (EC-LAMSs) which enable a one-step procedure, granting prevention of biliary leakage and minimizing occurrence of adverse events (AEs). In parallel, increasing evidence suggests a possible role of EUS-BD in the management of DMBO as a primary palliative drainage modality. In the current paper, we aim to review all the available evidence on the role of EUS-BD performed with EC-LAMSs and discuss salient technical aspects of this type of procedure. Full article
(This article belongs to the Special Issue Palliation of Gastrointestinal Tumors with Lumen Apposing Metal Stents)
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13 pages, 608 KiB  
Review
A Systematic Review of Endoscopic Treatments for Concomitant Malignant Biliary Obstruction and Malignant Gastric Outlet Obstruction and the Outstanding Role of Endoscopic Ultrasound-Guided Therapies
by Giacomo Emanuele Maria Rizzo, Lucio Carrozza, Dario Quintini, Dario Ligresti, Mario Traina and Ilaria Tarantino
Cancers 2023, 15(9), 2585; https://doi.org/10.3390/cancers15092585 - 30 Apr 2023
Cited by 4 | Viewed by 1842
Abstract
Background: The treatments for cancer palliation in patients with concomitant malignant biliary obstruction (MBO) and gastric outlet obstruction (MGOO) are still under investigation due to the lack of evidence available in the medical literature. We performed a systematic search and critical review to [...] Read more.
Background: The treatments for cancer palliation in patients with concomitant malignant biliary obstruction (MBO) and gastric outlet obstruction (MGOO) are still under investigation due to the lack of evidence available in the medical literature. We performed a systematic search and critical review to investigate efficacy and safety among patients with MBO and MGOO undergoing both endoscopic ultrasound-guided biliary drainage (EUS-BD) and MGOO endoscopic treatment. Methods: A systematic literature search was performed in PubMed, MEDLINE, EMBASE, and the Cochrane Library. EUS-BD included both transduodenal and transgastric techniques. Treatment of MGOO included duodenal stenting or EUS-GEA (gastroenteroanastomosis). Outcomes of interest were technical success, clinical success, and rate of adverse events (AEs) in patients undergoing double treatment in the same session or within one week. Results: 11 studies were included in the systematic review for a total number of 337 patients, 150 of whom had concurrent MBO and MGOO treatment, fulfilling the time criteria. MGOO was treated by duodenal stenting (self-expandable metal stents) in 10 studies, and in one study by EUS-GEA. EUS-BD had a mean technical success of 96.4% (CI 95%, 92.18–98.99) and a mean clinical success of 84.96% (CI 95%, 67.99–96.26). The average frequency of AEs for EUS-BD was 28.73% (CI 95%, 9.12–48.33). Clinical success for duodenal stenting was 90% vs. 100% for EUS-GEA. Conclusions: EUS-BD could become the preferred drainage in the case of double endoscopic treatment of concomitant MBO and MGOO in the near future, with the promising EUS-GEA becoming a valid option for MGOO treatment in these patients. Full article
(This article belongs to the Special Issue Palliation of Gastrointestinal Tumors with Lumen Apposing Metal Stents)
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14 pages, 1702 KiB  
Review
Endoscopic Ultrasound Guided Biliary Drainage in Malignant Distal Biliary Obstruction
by Danilo Paduano, Antonio Facciorusso, Alessandro De Marco, Andrew Ofosu, Francesco Auriemma, Federica Calabrese, Ilaria Tarantino, Gianluca Franchellucci, Andrea Lisotti, Pietro Fusaroli, Alessandro Repici and Benedetto Mangiavillano
Cancers 2023, 15(2), 490; https://doi.org/10.3390/cancers15020490 - 12 Jan 2023
Cited by 9 | Viewed by 2933
Abstract
Malignant biliary obstruction (MBO) is a challenging medical problem that often negatively impacts the patient’s quality of life (QoL), postoperative complications, and survival rates. Endoscopic approaches to biliary drainage are generally performed by ERCP or, in selected cases, with a percutaneous transhepatic biliary [...] Read more.
Malignant biliary obstruction (MBO) is a challenging medical problem that often negatively impacts the patient’s quality of life (QoL), postoperative complications, and survival rates. Endoscopic approaches to biliary drainage are generally performed by ERCP or, in selected cases, with a percutaneous transhepatic biliary drainage (PTBD). Recent advances in therapeutic endoscopic ultrasound (EUS) allow drainage where previous methods have failed. EUS has evolved from a purely diagnostic technique to one that allows a therapeutic approach in the event of ERCP failure in distal MBO. Moreover, the introduction of dedicated accessories and prostheses for EUS-guided transmural biliary drainage (EUS-BD) made these procedures more successful with regard to technical success, clinical outcomes and reduction of adverse events (AEs). Finally, lumen-apposing metal stents (LAMS) have improved the therapeutic role of the EUS. Subsequently, the electrocautery enhanced tip of the LAMS (EC-LAMS) allows a direct access of the delivery system to the target lumen, thereby simplifying and reducing the EUS-BD procedure time. EUS-BD using LAMS and EC-LAMS has proven effective and safe with a low rate of AEs. This review aims to evaluate biliary drainage techniques in malignant obstruction, focusing on the role of EUS biliary drainage by LAMS. Full article
(This article belongs to the Special Issue Palliation of Gastrointestinal Tumors with Lumen Apposing Metal Stents)
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Other

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12 pages, 864 KiB  
Systematic Review
Methods for Drainage of Distal Malignant Biliary Obstruction after ERCP Failure: A Systematic Review and Network Meta-Analysis
by Antonio Facciorusso, Benedetto Mangiavillano, Danilo Paduano, Cecilia Binda, Stefano Francesco Crinò, Paraskevas Gkolfakis, Daryl Ramai, Alessandro Fugazza, Ilaria Tarantino, Andrea Lisotti, Pietro Fusaroli, Carlo Fabbri and Andrea Anderloni
Cancers 2022, 14(13), 3291; https://doi.org/10.3390/cancers14133291 - 5 Jul 2022
Cited by 10 | Viewed by 2303
Abstract
There is scarce evidence on the comparison between different methods for the drainage of distal malignant biliary obstruction (DMBO) after endoscopic retrograde cholangiopancreatography (ERCP) failure. Therefore, we performed a network meta-analysis to compare the outcomes of these techniques. We searched main databases through [...] Read more.
There is scarce evidence on the comparison between different methods for the drainage of distal malignant biliary obstruction (DMBO) after endoscopic retrograde cholangiopancreatography (ERCP) failure. Therefore, we performed a network meta-analysis to compare the outcomes of these techniques. We searched main databases through September 2021 and identified five randomized controlled trials. The primary outcome was clinical success. The secondary outcomes were technical success, overall and serious adverse event rate. Percutaneous trans-hepatic biliary drainage was found to be inferior to other interventions (PTBD: RR 1.01, 0.88–1.17 with EUS-choledochoduodenostomy (EUS-CD); RR 1.03, 0.86–1.22 with EUS-hepaticogastrostomy (EUS-HG); RR 1.42, 0.90–2.24 with surgical hepaticojejunostomy). The comparison between EUS-HG and EUS-CD was not significant (RR 1.01, 0.87–1.17). Surgery was not superior to other interventions (RR 1.40, 0.91–2.13 with EUS-CD and RR 1.38, 0.88–2.16 with EUS-HG). No difference in any of the comparisons concerning adverse event rate was detected, although PTBD showed a slightly poorer performance on ranking analysis (SUCRA score 0.13). In conclusion, all interventions seem to be effective for the drainage of DMBO, although PTBD showed a trend towards higher rates of adverse events. Full article
(This article belongs to the Special Issue Palliation of Gastrointestinal Tumors with Lumen Apposing Metal Stents)
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