IDIBELL - Bellvitge Biomedical Research Institute

The globus pallidus internus (GPi), a critical output structure of the basal ganglia, plays a central role in motor control by facilitating or inhibiting cortical commands through its connections with the thalamus. This study investigates the involvement of the GPi and thalamus in inhibitory processes during a Go/No-Go task in six patients undergoing deep brain stimulation (DBS) for dystonia or Tourette syndrome. Local field potentials (LFPs) were recorded from externalized DBS electrodes prior to pulse generator implantation. In line with recent computational models of the basal ganglia, we hypothesized differential activity in the GPi for Go and No-Go stimuli, reflecting its role in inhibitory functions. Our findings revealed distinct averaged LFP patterns in the GPi and thalamus to Go and No-Go stimuli, and in addition pronounced differences in beta-band time-frequency activity. These findings provide direct electrophysiological evidence for the GPi's involvement in proactive inhibition which paves the way for more fine-grained analyses of inhibitory functions.

EUS-guided biliary drainage, creating a choledochoduodenostomy and using lumen-apposing metal stents (LAMS), is a promisingintervention for the management of malignant distal biliary obstruction (MDBO). But concerns exist regarding its stent patency. Our aim was to determine whether the insertion of an axis-orienting double-pigtail plastic stent (DPS) through LAMS offered a clinical benefit by improving the stent dysfunction rate.

This multicenter randomized controlled trial was carried out in 7 tertiary hospitals. Patients with MDBO secondary to resectable, locally-advanced, or unresectable cancers, and indication for biliary drainage, were eligible for inclusion. Patients were randomly assigned (1:1) to either the LAMS group or the LAMS-DPS group. The primary endpoint was the rate of recurrent biliary obstruction (RBO), detected during follow-up. The secondary endpoints were technical and clinical success, safety, time-to-RBO, reinterventions, and hospitalization.

Between Nov. 2020, and Oct. 2022, we screened 123 patients with MDBO, of whom 91 were randomly assigned to LAMS (n=47) or LAMS-DPS (n=44). RBO rate was lower in the LAMS-DPS group (14[30%] of 47 patients vs 4[9%] of 44 patients; relative risk0.31[95%CI 0.09-0.78];p=0.024). Hospitalization was shorter in the LAMS-DPS group (median difference 4.5[95%CI 0, 9]; p=0.016). Procedure time was longer (21 vs 32-min, p=0.018) in the LAMS-DPS-group. No differences were found among technical, clinical success, and global adverse events (19 vs 27%; relative risk,1.42[95%CI 0.67-3.18];p=0.362).

In patients with malignant distal biliary obstruction, EUS-guided biliary drainage using LAMS with coaxial DPS was superior to LAMS alone. It offered clinical benefits including lower recurrent biliary obstruction rate and shorter hospitalization (ClinicalTrials.gov, number NCT04595058).