Tsuchiya T, et al. – The long–term outcome of EUS–guided choledochoduodenostomy (EUS–CDS) using a dedicated lumen–apposing metal stent (LAMS) was assessed in this prospective multicenter study. The researchers concluded that for EUS–CDS, the novel dedicated LAMS used has high technical and clinical success rates. The adverse events and patency rates were inferior to the historically reported data of a conventional transpapillary metal stent. Development of a more suitable dedicated LAMS was anticipated.

• The researchers treated 19 patients (mean age, 70.6 years; 12 men) with unresectable malignant diseases in 5 tertiary referral centers.
• They performed EUS-CDS using a fully covered LAMS with a cautery-enhanced delivery system for EUS-CDS.

• Without any adverse event, all stents were successfully deployed.
• Within 7 days, jaundice improved in 79% of the patients and finally in 95%.
• During the follow-up period, the stents remained in good anastomotic position without migration or dislocation in 95% of the patients (median, 184 days; range, 12-819 days).
• The day after the stent placement, 1 patient had a fever.
• 5 patients had secondary stent obstruction because of a food residue (n = 2), kinking (n = 1), suspected tumor ingrowth (n = 1), and spontaneous dislodgement (n = 1) during the follow-up period.
• An obstruction in the second portion of the duodenum was developed in 5 patients.
• As per the outcomes, the overall adverse event rate was 36.8% (7/19) mostly with mild severity.