From the Guidelines
The rate of LAMA migration after choledochoduodenostomy is not a relevant or established clinical concern, as LAMAs are inhaled medications for respiratory conditions and are not related to biliary procedures like choledochoduodenostomy. However, the provided evidence discusses the migration of covered self-expanding metal stents (SEMSs) in the biliary tract, which occurs in about 10% of cases 1. This information is not directly related to LAMA migration, as LAMAs are not implantable devices and do not migrate in the same way that stents can. Key points to consider in the management of patients with biliary disease and respiratory conditions include:
- The pharmacokinetics of inhaled LAMAs, which have minimal systemic absorption and undergo primarily hepatic metabolism, should not be significantly affected by biliary diversion procedures like choledochoduodenostomy.
- Standard LAMA dosing can generally be continued without adjustment after the patient recovers from surgery, as the procedure does not impact the medication's absorption or distribution. It is essential to prioritize the patient's overall health and manage their respiratory and biliary conditions separately, using established clinical guidelines and evidence-based practices 1.
From the Research
Rate of LAMS Migration after Choledochoduodenostomy
- The rate of LAMS migration after choledochoduodenostomy is reported in several studies, with varying frequencies:
- A study published in 2019 2 reported a migration rate of 1 out of 43 patients (2.3%) who underwent EUS-guided choledochoduodenostomy using a lumen-apposing metal stent.
- Another study published in 2018 3 reported that 1 out of 19 patients (5.3%) experienced spontaneous dislodgement of the stent.
- A systematic review and meta-analysis published in 2020 4 reported a pooled rate of recurrent jaundice, which may be related to stent migration, of 8.7% (95% CI 4.5-12.8).
- The factors that contribute to LAMS migration are not fully understood, but may include:
- Stent design and size
- Patient anatomy and disease characteristics
- Technical factors related to stent placement
- The clinical significance of LAMS migration is also not fully understood, but may include:
- Recurrent jaundice or cholangitis
- Need for repeat interventions or stent replacement
- Potential for complications such as bleeding or perforation
Comparison of Studies
- The studies included in this analysis reported varying rates of LAMS migration, ranging from 2.3% to 5.3%.
- The studies also reported different patient populations, stent designs, and technical factors, which may contribute to the variability in migration rates.
- Further studies are needed to fully understand the rate and clinical significance of LAMS migration after choledochoduodenostomy, as well as the factors that contribute to migration 5, 3, 2, 4.