Guidewire use in electrocautery-enhanced lumen-apposing metal stent procedures: Results of an online survey from an international working group.

BACKGROUND AND STUDY AIMS: This international survey aimed to characterize current practice patterns, perceptions, and outcomes related to guidewire use in electrocautery-enhanced lumen-apposing metal stents (EC-LAMS) procedures.

METHODS

An online survey of experienced therapeutic endoscopists was conducted, collecting information on preferred techniques, indications for guidewire use, perceived risks, and self-reported adverse events (AEs). Post-hoc analyses explored associations between guidewire use, AEs, and operator experience.

RESULTS

Eighty-seven endoscopists (mean age 46.1 years, 88.5% with ≥ 5 years of endoscopic ultrasound (EUS) experience) completed the survey. Freehand deployment was the preferred technique for the majority of all procedures. Guidewire use was mainly preferred for EUS-guided choledochoduodenostomy (EUS-CDS, 24.1%) and EUS-directed transgastric endoscopic retrograde cholangiopancreatography (EDGE, 31%). Reported factors favoring guidewire use included small target lumens and difficult scope positioning. Maldeployment was reported as the most important complication, because 49.3%, and 40.6% of the participants reported at least one maldeployment case in EUS-CDS and EUS-guided gastroenterostomy, respectively. Logistic regression showed that guidewire use in EUS-CDS was perceived to result in higher complication rates (44.1% vs 20.0%; odds ratio 3.16, 95% confidence interval 1.08-9.2, P = 0.03). No significant differences in outcomes or guidewire use were observed by operator experience or case volume, although older endoscopists were more likely to use guidewires.

CONCLUSIONS

Using an international questionnaire for experienced EUS operators, freehand deployment was identified as the predominant technique for EC-LAMS placement.