Yen-I Chen, MD: EUS-CDL Comparable to ERCP-M in ELEMENT Trial

New research from the ELEMENT trial found endosonography choledochoduodenostomy with a lumen apposing metal stent (EUS-CDL) is more efficient than endoscopic retrograde cholangiopancreatography with metal stent insertion (ERCP-M), with comparable short-term effectiveness and safety for malignant distal biliary obstruction (MDBO).

Additionally, EUS-CDL was able to be performed without fluoroscopy while facilitating same session tissue acquisition, according to investigators, who noted it as a viable and practical first-line alternative.

The study was presented at the 2022 Digestive Disease Week Annual Meeting in San Diego, California.

“Overall, we have a very comparable technology to ERCP,” said Yen-I Chen, Department of Medicine, McGill University, in an interview with HCPLive. “This is the first real modality that's challenging most ERCP in terms of first line treatment. And we will see where it stands finally with the rate of stent dysfunction that will come in about six months from now.”

Chen noted that following failed ERCP, the usual approach is towards percutaneous drainage, but more often, they are performing EUS biliary drainage. He noted this strengthens the argument to do this as a second intent, while additionally strengthening it as a first intent procedure with comparable modality observed.

He noted that they need to know the rate of stent dysfunction before a final conclusion is made and safe regarding adverse events. Although the randomized controlled data show equivalent findings, more patients are needed to confirm, Chen said.

“In terms of practice, I think more and more you’ll see this being performed first-line,” Chen explained. “There’s certain situations, certain patient populations, whether there’s a little bit of gastric outlet obstruction, or that you just want the practicality of doing the biopsy and getting the stent in a very fast fashion.”

The study, “Endoscopic Ultrasound-Guided Biliary Drainage of First Intent with a Lumen-Apposing Metal Stent Vs. Endoscopic Retrograde Cholangiopancreatography in Malignant Distal Biliary Obstruction: A Multicenter Randomized Controlled Trial (ELEMENT Trial),” was presented at DDW 2022.