Endoscopy 2025; 57(04): 330-338
DOI: 10.1055/a-2463-1601
Original article

Stent misdeployment and factors associated with failure in endoscopic ultrasound-guided choledochoduodenostomy: analysis of the combined datasets from two randomized trials

 1   Division of Gastroenterology and Hepatology, McGill University Health Centre, Montreal, Quebec, Canada
,
Clara Long
 1   Division of Gastroenterology and Hepatology, McGill University Health Centre, Montreal, Quebec, Canada
,
Anand V. Sahai
 2   Service de Gastroentérologie, Centre Hospitalier de l’Université de Montréal, Montréal, Quebec, Canada
,
 3   Hopital Privé Jean Mermoz, Ramsay Santé, Lyon, France
,
 4   Unité d’Endoscopie Interventionnelle, Hôpital Privé des Peupliers, Paris, France
,
Rastislav Kunda
 5   Department of Surgery, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
 6   Department of Gastroenterology-Hepatology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
 7   Department of Advanced Interventional Endoscopy, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
 8   Department of Surgical Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
,
Myriam Martel
 1   Division of Gastroenterology and Hepatology, McGill University Health Centre, Montreal, Quebec, Canada
,
 9   Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
,
10   Pancreato-Biliary Endoscopy and Endosonography Division, Pancreas Translational and Clinical Research Center, San Raffaele Scientific Institute IRCCS, Vita Salute San Raffaele University, Milan, Italy
,
Eric Lam
11   Division of Gastroenterology and Hepatology, St-Paul Hospital, Vancouver, British Columbia, Canada
,
12   Division of Hospital and Ambulatory Medicine and Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
,
13   Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Alberta, Canada
,
Alberto Larghi
14   Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
,
Jeffrey D. Mosko
15   Division of Gastroenterology, St-Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada
,
Schalk Van der Merwe
16   Department of Gastroenterology and Hepatology, The University of Leuven, Leuven, Belgium
,
Seng Ian Gan
17   Division of Gastroenterology and Hepatology, Vancouver General Hospital, Vancouver, British Columbia, Canada
,
Jeremie Jacques
18   Gastroenterology Department, Dupuytren University Hospital, Limoges, France
,
Sana Kenshil
19   Division of Gastroenterology and Hepatology, Ottawa Hospital, Ottawa, Ontario, Canada
,
Thawee Ratanachu-Ek
20   Department of Surgery, Rajavithi Hospital, Bangkok, Thailand
,
Corey Miller
21   Division of Gastroenterology and Hepatology, Jewish General Hospital, Montreal, Quebec, Canada
,
Payal Saxena
22   Department of Gastroenterology, Royal Prince Alfred Hospital, Sidney, Australia
,
Etienne Desilets
23   Division of Gastroenterology, Hôpital Charles-Le Moyne, Longeuil, Quebec, Canada
,
24   Division of Gastroenterology and Hepatology, University of Alberta Hospital, Edmonton, Alberta, Canada
,
Yousef Alrifae
 1   Division of Gastroenterology and Hepatology, McGill University Health Centre, Montreal, Quebec, Canada
,
 9   Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
,
on behalf of the ELEMENT and DRA-MBO working groups
› Author Affiliations
Fonds de Recherche du Québec – Santé http://dx.doi.org/10.13039/501100000156Institute of Nutrition, Metabolism and Diabetes http://dx.doi.org/10.13039/501100000035
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Abstract

Background Stent misdeployment (SMD) is a feared and poorly characterized technical challenge of endoscopic ultrasound (EUS)-guided choledochoduodenostomy (CDS) using lumen-apposing stents. We aimed to ascertain the rate of stent misdeployment in EUS-CDS for malignant distal biliary obstruction (MDBO) and describe its outcomes while identifying variables associated with its occurrence.

Method This was a post hoc analysis of two randomized controlled trials comparing EUS-CDS vs. endoscopic retrograde cholangiopancreatography in MDBO. The primary end point was rate of SMD, classified as misdeployment of the distal flange (type I), proximal flange (type II), contralateral bile duct wall injury (type III), or double mucosal puncture (type IV). Multivariable analysis was performed to identify variables associated with SMD and/or technical failure, and with clinical failure or stent dysfunction.

Results 152 patients were included. Technical success was 93.4 %. SMD occurred in 11 patients (7.2 %; 95 %CI 3.1 %–11.4 %): 8 type I, 1 type II, and 2 type III. Endoscopic salvage of SMD was successful in 81.8 %. Misdeployment led to adverse events in four patients (two mild, two moderate), giving an overall SMD-related adverse event rate of 2.6 % (95 %CI 0.7 %–6.6 %). On multivariable analysis, extrahepatic bile duct diameter of ≤ 15 mm was associated with increased odds of SMD and/or technical failure.

Conclusion SMD was relatively common in EUS-CDS and was associated with an extrahepatic bile duct diameter of ≤ 15 mm. The majority of misdeployments could be rescued endoscopically with low risk for adverse events.

Supplementary Material



Publication History

Received: 22 February 2024

Accepted after revision: 06 November 2024

Accepted Manuscript online:
06 November 2024

Article published online:
16 December 2024

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