Lumen-apposing metal stents for malignant biliary obstruction: Is this the ultimate horizon of our experience?

摘要: In the last years, endoscopic ultrasonography (EUS) has evolved from a purely diagnostic technique to more and complex interventional procedure, with possibility perform several type of therapeutic interventions. Among these, EUS-guided biliary drainage (BD) is gaining popularity as approach after failed retrograde cholangiopancreatography in distal malignant obstruction (MBO), due avoidance external drainage, lower rate adverse events re-interventions, costs compared percutaneous trans-hepatic BD. Initially, devices created for luminal procedures (e.g., stents) have been adapted new trans-luminal interventions, predictable shortcomings technical success, outcome events. More recently, metal stents specifically designed transluminal namely lumen-apposing (LAMS), made available procedures. An electrocautery enhanced delivery system (EC-LAMS), which allows direct access target lumen, subsequently simplified classic multi-step procedure drainages. EUS-BD using LAMS EC-LAMS demonstrated effective safe, currently seems one most performing techniques EUS-BD. this Review, we summarize evolution MBO, focusing on novelty analyzing unresolved questions about possible role EUS first option achieve BD setting patients.