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CC BY-NC-ND 4.0 · Endosc Int Open 2022; 10(04): E429-E433
DOI: 10.1055/a-1783-9310
Original article

Endoscopic stenting for malignant biliary obstruction is technically successful in patients with preexisting duodenal stents

Priya K. Simoes
1   Mount Sinai Health System – Medicine, Division of Gastroenterology and Hepatology, New York, New York, United States
,
Mark A. Schattner
2   Memorial Sloan Kettering Cancer Center – Medicine, Gastroenterology and Nutrition Service, New York, New York, United States
,
Hans Gerdes
2   Memorial Sloan Kettering Cancer Center – Medicine, Gastroenterology and Nutrition Service, New York, New York, United States
,
Pari M. Shah
2   Memorial Sloan Kettering Cancer Center – Medicine, Gastroenterology and Nutrition Service, New York, New York, United States
,
Robert C. Kurtz
2   Memorial Sloan Kettering Cancer Center – Medicine, Gastroenterology and Nutrition Service, New York, New York, United States
,
Robin B. Mendelsohn
3   Memorial Sloan Kettering Cancer Center – Medicine, Division of Gastroenterology, Hepatology and Nutrition, New York, New York, United States
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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/)

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