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DOI: 10.1055/a-2439-3793
Endoscopic ultrasound-guided choledochoduodenostomy using an innovatively shaped self-expandable metal stent to prevent stent migration
Endoscopic ultrasound-guided choledochoduodenostomy (EUS-CDS) is now widely performed, not only as an alternative biliary drainage technique when endoscopic retrograde cholangiopancreatography (ERCP) fails, but also as primary drainage for unresectable malignant distal biliary obstruction [1] [2] [3]. The adverse event of stent migration sometimes occurs. In addition, EUS-CDS using a lumen-apposing metal stent (LAMS) has been reported, but if the common bile duct is not very dilated, this technique might be challenging, and misdeployment might occur, especially in nonexpert hands.
A novel tapered self-expandable metal stent (T-SEMS) (K-papilla biliary stent; S&G Biotech, Seoul, Korea) is now available in Japan ([Fig. 1]). The main body of the T-SEMS has a diameter of 10 mm, but the stent is tapered toward the ampulla of Vater area, and at the ampulla of Vater the body diameter of the T-SEMS is 8 mm. With this unique design, an expanding force works toward the hepatic hilar region, and stent dislocation can be prevented. In addition, a wide flare (16 mm in diameter) at the duodenal end prevents stent migration. Furthermore, the absence of flare at the distal end prevents stent-induced ductal change. This stent might be useful to prevent stent dislocation and migration not only related to ERCP, but also to EUS-CDS. Herein, technical tips for EUS-CDS using T-SEMS are provided.


An 81-year-old man was admitted to our hospital because of obstructive jaundice caused by cancer of the head of the pancreas. Because of failed biliary cannulation due to tumor invasion into the ampulla of Vater, EUS-CDS was attempted. First, the common bile duct was punctured using a 19-G needle, and the contrast medium was injected ([Fig. 2]). After a 0.025-inch guidewire was deployed within the biliary tract ([Fig. 3]), the common bile duct and duodenal wall were dilated using a 4-mm balloon catheter. Then, the stent delivery system of the T-SEMS was successfully inserted and deployed ([Fig. 4]), without any adverse events. Although the proximal site of the stent was short, to prevent duodenal mucosal injury, no stent migration was observed after 7 days ([Fig. 5], [Video 1]).








In conclusion, the T-SEMS might be useful to prevent stent dislocation and migration not only related to ERCP, but also to EUS-CDS, although a comparison study is needed.
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Conflict of Interest
The authors declare that they have no conflict of interest.
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References
- 1 Yamazaki H, Yamashita Y, Shimokawa T. et al. Endoscopic ultrasound-guided hepaticogastrostomy versus choledochoduodenostomy for malignant biliary obstruction: a meta-analysis. DEN Open 2023; 4: e274
- 2 Mukai S, Itoi T. Preoperative endoscopic ultrasound-guided biliary drainage for primary drainage in obstructive jaundice. Expert Rev Gastroenterol Hepatol 2023; 17: 1197-1204
- 3 Teoh AYB, Napoleon B, Kunda R. et al. EUS-guided choledocho-duodenostomy using lumen apposing stent versus ERCP with covered metallic stents in patients with unresectable malignant distal biliary obstruction: a multicenter randomized controlled trial (DRA-MBO Trial). Gastroenterology 2023; 165: 473-482.e2
Correspondence
Publication History
Article published online:
08 November 2024
© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).
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References
- 1 Yamazaki H, Yamashita Y, Shimokawa T. et al. Endoscopic ultrasound-guided hepaticogastrostomy versus choledochoduodenostomy for malignant biliary obstruction: a meta-analysis. DEN Open 2023; 4: e274
- 2 Mukai S, Itoi T. Preoperative endoscopic ultrasound-guided biliary drainage for primary drainage in obstructive jaundice. Expert Rev Gastroenterol Hepatol 2023; 17: 1197-1204
- 3 Teoh AYB, Napoleon B, Kunda R. et al. EUS-guided choledocho-duodenostomy using lumen apposing stent versus ERCP with covered metallic stents in patients with unresectable malignant distal biliary obstruction: a multicenter randomized controlled trial (DRA-MBO Trial). Gastroenterology 2023; 165: 473-482.e2









