Multicenter experience with performance of ERCP in patients with an indwelling duodenal stent

Abstract

Endoscopic retrograde cholangiopancreatography (ERCP) in patients with a preexisting duodenal stent covering the papilla is particularly challenging. The aim of this study was to describe a multicenter experience of performing ERCP in patients with biliary obstruction in whom the papilla was obscured by a preexisting duodenal stent. A total of 38 patients with preexisting duodenal stents obscuring the papilla underwent ERCP. Endoscopic biliary cannulation was successful in 13 patients (34.2 %). In 12 of these 13 patients (92.3 %), endoscopic therapy was performed during the same procedure and achieved clinical success with relief of jaundice in all cases (100 %). The most commonly utilized procedure in patients in whom ERCP failed was EUS-guided biliary drainage (EGBD; n = 13 /22, 59.1 %), followed by percutaneous transhepatic biliary drainage (n = 9 /22, 40.9 %). Three patients in whom ERCP failed either did not consent to further intervention or were transferred to other centers. Thus, ERCP was technically challenging in our cohort of patients with preexisting duodenal stents, but was nonetheless successful in about one third of cases. Overall, when performed by experts, endoscopic biliary drainage (via ERCP or EGBD) can be successfully achieved in the majority of patients with indwelling duodenal stents.

Covered duodenal self‐expandable metal stents prolong biliary stent patency in double stenting: The largest series of bilioduodenal obstruction

“…The present study is the largest series to date, involving 109 patients with DS, not including endoscopic ultrasound (EUS)‐guided biliary drainage (EUS‐BD). The technical success rate of DS ranges from 82% to 100% . Our identified rate (99.1%) is similar to this, and clinical success was achieved in 81.7%.…”

“…Endoscopic stenting using self‐expandable metal stents (SEMSs) is an effective and minimally invasive treatment in cases of duodenal obstruction and for palliation of biliary obstruction . In recent years, biliary and duodenal stenting (DS; double stenting) has been used to treat combined biliary and duodenal obstructions . An uncovered SEMS (U‐SEMS) was used as the type of duodenal SEMS in most previous DS cases.…”

Endoscopic management of combined malignant biliary and gastric outlet obstruction

“…Khashab et al . reported the utility of EUS‐guided rendezvous (EUS‐RV) whereas transpapillary biliary access was successful in 34.2% only . However, the success rate of EUS‐RV was not sufficiently high, as Park et al .…”

“…As one of the advantages of EUS‐guided transmural stent placement is a lack of post‐procedure pancreatitis, the risk of pancreatitis should be considered especially in patients without pancreatic duct obstruction if EUS‐AG stent placement is to be carried out. In summary, for the management of combined MBO and GOO, EUS‐BD can potentially be the standard procedure in terms of both technical reasons and clinical outcomes . However, safety and efficacy of EUS‐BD reported in the literature are only carried out by experts, and the dedicated devices are still lacking.…”

“…In summary, for the management of combined MBO and GOO, EUS-BD can potentially be the standard procedure in terms of both technical reasons and clinical outcomes. 14,46,57 However, safety and efficacy of EUS-BD reported in the literature are only carried out by experts, and the dedicated devices are still lacking. Its generalizability is yet to be clarified and the development of dedicated devices is essential for standardization of this novel procedure.…”