Guidewire Use in Electrocautery-Enhanced Lumen-Apposing Metal Stent Procedures: Results of an Online Survey from an International Working Group

Background and study aim: 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. Post-hoc analyses explored associations between guidewire use, adverse events, and operator experience. Results: Eighty-seven endoscopists (mean age 46.1 years, 88.5% with ≥5 years of EUS experience) completed the survey. Freehand deployment was the preferred technique for the majority of all procedures. Guidewire use was mainly preferred for endoscopic ultrasound guided choledochoduodenostomy (EUS-CDS, 24.1%) and EUS-directed transgastric ERCP (EDGE, 31%). Reported factors favoring guidewire use included small target lumens and difficult scope positioning. Maldeployment was reported as the most important complication, as 49.3%, and 40.6% of the participants reported at least one maldeployment case in EUS-CDS and EUS-guided gastroenterostomy (EUS-GE), respectively. Logistic regression showed guidewire use in EUS-CDS was perceived to result in higher complication rates (44.1% vs 20.0%; OR 3.16, 95% CI 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.