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Biliary ObstructionNCT03870386

EUS Biliary Drainage vs. ERCP

A study testing EUS-BD with LAMS and ERCP in people with Biliary Obstruction, run by McGill University Health Centre/Research Institute of the McGill University Health Centre at 11 sites in 2 countries.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

Endoscopic ultrasound guided biliary drainage (EUS-BD) is an evolving field that has grown in popularity in the management of malignant biliary obstruction. Although Endoscopic retrograde cholangio-pancreatography (ERCP) with stent insertion has been the mainstay therapy throughout several decades, the transpapillary… Read more about this study

Who is it for?
Ages 18 years and older
Conditions the study is for
Biliary Obstruction
What is being tested?
EUS-BD with LAMS and ERCP
Could I receive a placebo?
No, everyone receives an active treatment
How many people
144 participants
Where
11 sitesin 2 countries
Study dates
8 Mar 2019to 1 Jul 2023
Phase
Interventional
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Radiological diagnosis (with or without pathological diagnosis) of borderline resectable, locally advanced, or unresectable malignant distal biliary obstruction at least 2 cm distal to the hilum. Resectability based on tumor staging on axial imaging and surgeon evaluation.
  • Elevated liver tests with serum bilirubin at least 3 times above the upper limit of normal (18.9 umol/L)
  • Dilated extra-hepatic bile duct measuring at least 1.2 cm on axial imaging or US
  • Confirmation of bile duct accessibility and size of at least 1.2 cm on endoscopic ultrasound
  • Karnofsky index > 30%
  • ASA score <IV
  • Provision of informed consent

Who cannot join

  • Hilar obstruction (biliary obstruction < 2 cm from the hilum)
  • Uncorrectable coagulopathy and/or thrombocytopenia
  • Age < 18
  • Liver metastasis involving > 30% of the liver volume
  • Liver cirrhosis with portal hypertension or ascites
  • Prior biliary sphincterotomy or stent placement
Show all 9Show fewer
  • Surgically altered anatomy
  • Common bile duct measuring less than 1.2 cm will be excluded
  • Patient with clinical and radiological evidence of gastric outlet obstruction

Trial locations and contacts

11 sites in 2 countries.

11 sites in 2 countries

Canada10 sites
  • University of Calgary

    Calgary, Alberta

  • University of Alberta

    Edmonton, Alberta

  • Centre Hospitalier Universite de Montreal

    Montreal, Quebec, H2X3E4

  • McGill University Health Centre

    Montreal, Quebec, H3G 1A4

  • Hopital Charles Lemoynes

    Montreal, Quebec

  • Jewish General Hospital

    Montreal

  • The Ottawa Hospital

    Ottawa, Ontario

  • St-Michael's Hospital

    Toronto, Ontario, M5B 1W8

  • Vancouver General Hospital

    Vancouver, Bristish Columbia

  • St-Paul Hospital

    Vancouver, British Columbia

Other trials in Canada

France1 site
  • Hôpital Privé des Peupliers

    Paris

Other trials in France

About this study

Official title: EUS-guided Biliary Drainage of First Intent With the Lumen Apposing Metal Stent vs. ERCP in the Management of Malignant Distal Biliary Obstruction: a Randomized Controlled Trial

Endoscopic ultrasound guided biliary drainage (EUS-BD) is an evolving field that has grown in popularity in the management of malignant biliary obstruction. Although Endoscopic retrograde cholangio-pancreatography (ERCP) with stent insertion has been the mainstay therapy throughout several decades, the transpapillary approach through tumor tissue is associated with significant risk for adverse events such as post-ERCP pancreatitis and stent dysfunction from tumor tissue overgrowth and ingrowth. EUS-BD, through the creation of a choledochoduodenostomy with a stent, has the potential advantage of avoiding the papilla and its associated complications while potentially improving stent patency with lower risks for tumor tissue ingrowth and/or overgrowth.

Being tested
EUS-BD with LAMS, ERCP
Keywords
EUS, ERCP, Lumen apposing metal stent, Biliary drainage, Biliary obstruction, Pancreatic adenocarcinoma

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • EUS-BD with LAMSProcedure or surgery

    Endoscopic ultrasound guided insertion of lumen apposing metal stent forming a choledochoduodenostomy

  • ERCPProcedure or surgery

    Endoscopic retrograde cholangiopancreatography to localize and cannulate the bile duct using the guidewire-assisted technique.

Study groups in NCT03870386
Study groupRoleWhat they receive
EUS-BD with LAMSExperimentalA curvilinear endoscope is inserted orally and advanced to the duodenal bulb. Biliary accessibility is confirmed via EUS and with Doppler to rule out any intervening vessels. For common bile ducts < 15 mm in diameter, the biliary access is established via needle puncture with a 19-gauge needle followed by advancement of a 0.035 or 0.025 inch guidewire. A LAMS (AxiosTM) will then be inserted with cautery assistance without tract dilation and deployed. For common bile ducts > 15 mm, the need for initial needle puncture and wire insertion is at the discretion of the endoscopist. A cholangiogram is then performed through the LAMS with contrast injection. The choice of stent size will be at the discretion of the endoscopist (8 x 8 mm or 6 x 8 mm).
Receives: Procedure: EUS-BD with LAMS
Traditional transpapillary metal stent via ERCPActive comparatorA duodenoscope is advanced orally to the papilla. The bile duct is then cannulated with a sphincterotome using the guidewire-assisted technique. A cholangiogram is then performed followed by insertion of a self-expanding metal biliary stent. The performance of a biliary sphincterotomy prior to stent insertion and the choice of stent size (10x 40 mm, 10 x 60 mm, 10x 80 mm) will be at the discretion of the endoscopist.
Receives: Procedure: ERCP

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Rate of re-intervention

    Obstruction and/or migration of stent

    Measured: 1 year

Secondary outcomes (4)
  1. Technical success

    successful insertion of a transpapillary stent or choledochoduodenostomy stent at the initial procedure at time of randomization

    Measured: 1 year

  2. Clinical success

    50% decrease in bilirubin < 2 weeks post-stent insertion or less than 25% of pre-procedure bilirubin level within 4 weeks post stent insertion

    Measured: 1 year

  3. Stent patency

    mean time to stent obstruction or migration

    Measured: 1 year

  4. Early adverse events

    as per the ASGE lexicon for endoscopic adverse events13 including post-procedural pancreatitis defined as new or worsening abdominal pain persistent for at least 24 hours and requiring analgesics after ERCP or EUS-BD with an elevated amylase or lipase of greater than three times the upper limit of normal, peri-procedural bleeding defined as hematemesis and/or melena or hemoglobin drop > 2 g, intestinal perforation defined as evidence of air or luminal contents outside the GI tract, and cholangitis >38 Celsius for greater than 24 hours with cholestatic liver enzymes

    Measured: 1 year

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted12 Mar 2019
  2. Study start8 Mar 2019
  3. Primary completion1 May 2023
  4. Study completion1 Jul 2023

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Single group
Masking
Double blind
Who is masked
Participant, Outcomes assessor
Enrolment
144 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT03870386
Sponsor's protocol ID
F11-36171
Status last verified
Aug 2023
First submitted
9 Mar 2019
Last updated
14 Aug 2023
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Publications

  • Boulay BR, Lo SK. Endoscopic Ultrasound-Guided Biliary Drainage. Gastrointest Endosc Clin N Am. 2018 Apr;28(2):171-185. doi: 10.1016/j.giec.2017.11.005. Epub 2018 Feb 3.

    PubMed 29519330
  • Khashab MA, Messallam AA, Penas I, Nakai Y, Modayil RJ, De la Serna C, Hara K, El Zein M, Stavropoulos SN, Perez-Miranda M, Kumbhari V, Ngamruengphong S, Dhir VK, Park DH. International multicenter comparative trial of transluminal EUS-guided biliary drainage via hepatogastrostomy vs. choledochoduodenostomy approaches. Endosc Int Open. 2016 Feb;4(2):E175-81. doi: 10.1055/s-0041-109083. Epub 2016 Jan 15.

    PubMed 26878045
  • Khashab MA, Van der Merwe S, Kunda R, El Zein MH, Teoh AY, Marson FP, Fabbri C, Tarantino I, Varadarajulu S, Modayil RJ, Stavropoulos SN, Penas I, Ngamruengphong S, Kumbhari V, Romagnuolo J, Shah R, Kalloo AN, Perez-Miranda M, Artifon EL. Prospective international multicenter study on endoscopic ultrasound-guided biliary drainage for patients with malignant distal biliary obstruction after failed endoscopic retrograde cholangiopancreatography. Endosc Int Open. 2016 Apr;4(4):E487-96. doi: 10.1055/s-0042-102648. Epub 2016 Mar 30.

    PubMed 27092334
  • Almadi MA, Barkun A, Martel M. Plastic vs. Self-Expandable Metal Stents for Palliation in Malignant Biliary Obstruction: A Series of Meta-Analyses. Am J Gastroenterol. 2017 Feb;112(2):260-273. doi: 10.1038/ajg.2016.512. Epub 2016 Nov 15.

    PubMed 27845340
  • Almadi MA, Barkun JS, Barkun AN. Stenting in Malignant Biliary Obstruction. Gastrointest Endosc Clin N Am. 2015 Oct;25(4):691-711. doi: 10.1016/j.giec.2015.06.002. Epub 2015 Aug 28.

    PubMed 26431598
  • American Society for Gastrointestinal Endoscopy (ASGE) Standards of Practice Committee; Anderson MA, Appalaneni V, Ben-Menachem T, Decker GA, Early DS, Evans JA, Fanelli RD, Fisher DA, Fisher LR, Fukami N, Hwang JH, Ikenberry SO, Jain R, Jue TL, Khan K, Krinsky ML, Malpas PM, Maple JT, Sharaf RN, Shergill AK, Dominitz JA, Cash BD. The role of endoscopy in the evaluation and treatment of patients with biliary neoplasia. Gastrointest Endosc. 2013 Feb;77(2):167-74. doi: 10.1016/j.gie.2012.09.029. Epub 2012 Dec 7. No abstract available.

    PubMed 23219047
  • Bang JY, Navaneethan U, Hasan M, Hawes R, Varadarajulu S. Stent placement by EUS or ERCP for primary biliary decompression in pancreatic cancer: a randomized trial (with videos). Gastrointest Endosc. 2018 Jul;88(1):9-17. doi: 10.1016/j.gie.2018.03.012. Epub 2018 Mar 21.

    PubMed 29574126
  • Lee TH, Choi JH, Park do H, Song TJ, Kim DU, Paik WH, Hwangbo Y, Lee SS, Seo DW, Lee SK, Kim MH. Similar Efficacies of Endoscopic Ultrasound-guided Transmural and Percutaneous Drainage for Malignant Distal Biliary Obstruction. Clin Gastroenterol Hepatol. 2016 Jul;14(7):1011-1019.e3. doi: 10.1016/j.cgh.2015.12.032. Epub 2015 Dec 31.

    PubMed 26748220
  • Paik WH, Lee TH, Park DH, Choi JH, Kim SO, Jang S, Kim DU, Shim JH, Song TJ, Lee SS, Seo DW, Lee SK, Kim MH. EUS-Guided Biliary Drainage Versus ERCP for the Primary Palliation of Malignant Biliary Obstruction: A Multicenter Randomized Clinical Trial. Am J Gastroenterol. 2018 Jul;113(7):987-997. doi: 10.1038/s41395-018-0122-8. Epub 2018 Jul 2.

    PubMed 29961772
  • Park JK, Woo YS, Noh DH, Yang JI, Bae SY, Yun HS, Lee JK, Lee KT, Lee KH. Efficacy of EUS-guided and ERCP-guided biliary drainage for malignant biliary obstruction: prospective randomized controlled study. Gastrointest Endosc. 2018 Aug;88(2):277-282. doi: 10.1016/j.gie.2018.03.015. Epub 2018 Mar 30.

    PubMed 29605722
  • Kunda R, Perez-Miranda M, Will U, Ullrich S, Brenke D, Dollhopf M, Meier M, Larghi A. EUS-guided choledochoduodenostomy for malignant distal biliary obstruction using a lumen-apposing fully covered metal stent after failed ERCP. Surg Endosc. 2016 Nov;30(11):5002-5008. doi: 10.1007/s00464-016-4845-6. Epub 2016 Mar 11.

    PubMed 26969661
  • Anderloni A, Fugazza A, Troncone E, Auriemma F, Carrara S, Semeraro R, Maselli R, Di Leo M, D'Amico F, Sethi A, Repici A. Single-stage EUS-guided choledochoduodenostomy using a lumen-apposing metal stent for malignant distal biliary obstruction. Gastrointest Endosc. 2019 Jan;89(1):69-76. doi: 10.1016/j.gie.2018.08.047. Epub 2018 Sep 4.

    PubMed 30189198
  • Cotton PB, Eisen GM, Aabakken L, Baron TH, Hutter MM, Jacobson BC, Mergener K, Nemcek A Jr, Petersen BT, Petrini JL, Pike IM, Rabeneck L, Romagnuolo J, Vargo JJ. A lexicon for endoscopic adverse events: report of an ASGE workshop. Gastrointest Endosc. 2010 Mar;71(3):446-54. doi: 10.1016/j.gie.2009.10.027. No abstract available.

    PubMed 20189503
  • Siegel RL, Miller KD, Jemal A. Cancer statistics, 2018. CA Cancer J Clin. 2018 Jan;68(1):7-30. doi: 10.3322/caac.21442. Epub 2018 Jan 4.

    PubMed 29313949
  • Liao WC, Chien KL, Lin YL, Wu MS, Lin JT, Wang HP, Tu YK. Adjuvant treatments for resected pancreatic adenocarcinoma: a systematic review and network meta-analysis. Lancet Oncol. 2013 Oct;14(11):1095-1103. doi: 10.1016/S1470-2045(13)70388-7. Epub 2013 Sep 12.

    PubMed 24035532

Questions about this trial

What is this clinical trial studying?

A study testing EUS-BD with LAMS and ERCP in people with Biliary Obstruction, run by McGill University Health Centre/Research Institute of the McGill University Health Centre at 11 sites in 2 countries.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 7 inclusion and 9 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 14 Aug 2023. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 11 sites in Canada, France. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Rate of re-intervention (time frame: 1 year). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT03870386, which also lists 28 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 14 Aug 2023.

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