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DOI: 10.1055/a-1783-9310
Endoscopic stenting for malignant biliary obstruction is technically successful in patients with preexisting duodenal stents
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Abstract
Background and study aims There are limited data on the success of endoscopic retrograde cholangiopancreatography (ERCP) in patients with malignant biliary and duodenal obstruction with a preexisting duodenal stent. The aim of this study was to evaluate patient and procedural outcomes of a cohort of patients with preexisting duodenal stents who underwent an attempt at ERCP for malignant biliary obstruction (MBO).
Patients and methods This was a single-center retrospective study on consecutive patients with a preexisting duodenal stent who underwent attempted ERCP for MBO. Technical success was defined as successful cannulation of the common bile duct, with successful dilation and/or deployment of a biliary stent under fluoroscopy. Clinical success was defined as number of patients in the entire group who underwent ERCP successfully with resolution of symptoms.
Results We identified 64 patients (73 % men, 74 % white, median age 62 years) with a preexisting duodenal stent who underwent 85 attempts at ERCP. ERCP was technically successful in 50 of 85 procedures (59 %). Overall ERCP was successful in 41 of 85 patients (48 %). ERCP was more likely to be successful in patients with Type 1 and 3 duodenal strictures than with Type 2 strictures (83 % and 92 % vs. 42 %, P < 0.01), in patients with a preexisting sphincterotomy (79% vs. 20 %, P = 0.01) or preexisting biliary stent (66 % vs. 34 %, P = 0.04). Adverse events included bleeding (n = 3), post-procedure fever (n = 3) and abdominal pain (n = 1).
Conclusions Although biliary stenting via ERCP is often technically challenging in patients with a prior duodenal stent, it is a safe and effective method of biliary drainage. ERCP should be attempted in patients with Type 1 and 3 duodenal strictures, a prior sphincterotomy or an indwelling biliary stent.
Publication History
Received: 09 July 2021
Accepted after revision: 29 November 2021
Article published online:
14 April 2022
© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)
Georg Thieme Verlag KG
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References
- 1 Kaw M, Singh S, Gagneja H. Clinical outcome of simultaneous self-expandable metal stents for palliation of malignant biliary and duodenal obstruction. Surg Endosc Interv Tech 2003; 17: 457-461
- 2 Moon JH, Choi HJ. Endoscopic double-metallic stenting for malignant biliary and duodenal obstructions. J Hepatobiliary Pancreat Sci 2011; 18: 658-663
- 3 Maire F, Hammel P, Ponsot P. et al. Long-term outcome of biliary and duodenal stents in palliative treatment of patients with unresectable adenocarcinoma of the head of pancreas. Am J Gastroenterol 2006; 101: 735-742
- 4 Mutignani M, Tringali A, Shah SG. et al. Combined endoscopic stent insertion in malignant biliary and duodenal obstruction. Endoscopy 2007; 39: 440-447
- 5 Khashab MA, Valeshabad AK, Leung W. et al. Multicenter experience with performance of ERCP in patients with an indwelling duodenal stent. Endoscopy 2014; 46: 252-255
- 6 Cotton PB, Eisen GM, Aabakken L. et al. A lexicon for endoscopic adverse events: report of an ASGE workshop. Gastrointest Endosc 2010; 71: 446-454
- 7 Dormann AJ. Endoscopic palliation and nutritional support in advanced gastric cancer. Dig Dis 2004; 22: 351-359
- 8 Moon JH, Choi HJ, Ko BM. et al. Combined endoscopic stent-in-stent placement for malignant biliary and duodenal obstruction by using a new duodenal metal stent (with videos). Gastrointest Endosc 2009; 70: 772-777
- 9 Yamao K, Kitano M, Takenaka M. et al. Outcomes of endoscopic biliary drainage in pancreatic cancer patients with an indwelling gastroduodenal stent: a multicenter cohort study in West Japan. Gastrointest Endosc 2018; 88: 66-75.e2
- 10 Khashab MA, Van der Merwe S, Kunda R. et al. 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; 4: E487-E496
- 11 Baron TH. Management of simultaneous biliary and duodenal obstruction: the endoscopic perspective. Gut Liver 2010; 4: S50-S56
- 12 Park DH, Jang JW, Lee SS. et al. EUS-guided biliary drainage with transluminal stenting after failed ERCP: predictors of adverse events and long-term results. Gastrointest Endosc 2011; 74: 1276-1284
- 13 Hamada T, Isayama H, Nakai Y. et al. Transmural biliary drainage can be an alternative to transpapillary drainage in patients with an indwelling duodenal stent. Dig Dis Sci 2014; 59: 1931-1938
- 14 Artifon ELA, Marson FP, Gaidhane M. et al. Hepaticogastrostomy or choledochoduodenostomy for distal malignant biliary obstruction after failed ERCP: is there any difference?. Gastrointest Endosc 2015; 81: 950-959
- 15 Sharaiha RZ, Kumta NA, Desai AP. et al. Endoscopic ultrasound-guided biliary drainage versus percutaneous transhepatic biliary drainage: predictors of successful outcome in patients who fail endoscopic retrograde cholangiopancreatography. Surg Endosc 2016; 30: 5500-5505
- 16 Tyberg A, Desai AP, Kumta NA. et al. EUS-guided biliary drainage after failed ERCP: a novel algorithm individualized based on patient anatomy. Gastrointest Endosc 2016; 84: 941-946
- 17 Matsumoto K, Kato H, Tsutsumi K. et al. Long-term outcomes and risk factors of biliary stent dysfunction after endoscopic double stenting for malignant biliary and duodenal obstructions. Dig Endosc 2017; 29: 617-625
- 18 Hori Y, Naitoh I, Hayashi K. et al. Covered duodenal self‐expandable metal stents prolong biliary stent patency in double stenting: The largest series of bilioduodenal obstruction. J Gastroenterol Hepatol 2018; 33: 696-703