Endoscopy 2025; 57(09): 990-1000
DOI: 10.1055/a-2541-2973
Original article

Technical failure of endoscopic ultrasound-guided choledochoduodenostomy: multicenter study on rescue techniques, consequences, and risk factors

Authors

  • Clara Beunon

    1   Department of Digestive Endoscopy, Université Paris Cité, Beaujon University Hospital (APHP), Clichy, France
    2   Department of Pancreatology and Digestive Oncology, Université Paris Cité, Beaujon University Hospital (APHP), CRMR PaRaDis Pancreatic Rare Diseases, Clichy, France
  • Antoine Debourdeau

    3   Gastroenterology Unit, CHU de Nîmes, CHU de Montpellier, Montpellier University MUSE, Montpellier, France
  • Marion Schaefer

    4   Hepato-Gastroenterology Department, Nancy Regional University Hospital Center, Nancy, France
  • Timothée Wallenhorst

    5   Gastroenterology Unit, CHU Rennes, Rennes, France
  • Enrique Perez-Cuadrado-Robles

    6   Department of Gastroenterology, Université Paris Cité, Hopital Européen Georges Pompidou (APHP), Paris, France
  • Arthur Belle

    7   Department of Gastroenterology, Université Paris Cité, Cochin University Hospital (APHP), Paris, France
  • Jean-Michel Gonzalez

     8   Department of Gastroenterology, Université Aix Marseille, Hôpital Nord (APHM), Marseille, France
  • Marine Camus Duboc

     9   Department of Endoscopy, Université Sorbonne, Saint Antoine University Hospital (APHP), Paris, France
  • Fabrice Caillol

    10   Department of Gastroenterology, Institut Paoli Calmettes, Marseille, France
  • Hervé-Pierre Toudic

    11   Gastroenterology Department, Brest University Hospital, Brest, France
  • Mathieu Pioche

    12   Gastroenterology Unit, Hôpital Edouard Herriot, Lyon, France
  • Jean Baptiste Danset

    13   Gastroenterology Unit, Hôpital Saint-Joseph, Paris, France
  • Adrien Sportes

    14   Gastroenterology Unit, Institut Arnault Tzanck, Saint Laurent du Var, France
  • Bertrand Brieau

    15   Gastroenterology Unit, Clinique Jules Vernes, Nantes, France
  • Emmanuel Ben Soussan

    16   Gastroenterology Unit, Clinique de l’Alma, Paris, France
  • Mathilde Petiet

    17   Gastroenterology Unit, Grand Hôpital de l’Est Francilien, Meaux, France
  • Antoine Martin

    18   Gastroenterology Unit, CHU Hôpital Bicêtre (APHP), Kremlin-Bicêtre, France
  • Sarra Oumrani

    19   Gastroenterology Unit, CHUV, Lausanne, Switzerland
  • Frédérique Maire

    2   Department of Pancreatology and Digestive Oncology, Université Paris Cité, Beaujon University Hospital (APHP), CRMR PaRaDis Pancreatic Rare Diseases, Clichy, France
  • Arnaud Lemmers

    20   Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Erasme Hospital, HUB (Hôpital Universitaire de Bruxelles), ULB (Université Libre de Bruxelles), Brussels, Belgium
  • Frédéric Prat

    1   Department of Digestive Endoscopy, Université Paris Cité, Beaujon University Hospital (APHP), Clichy, France
  • Ludovic Caillo

    21   Gastroenterology Unit, CHU de Nîmes, Montpellier Univ, MUSE, France
  • Romain Gérard

    22   Gastroenterology and Endoscopy Unit, CHU Lille, Lille, France
  • Jérémie Albouys

    23   Gastroenterology and Endoscopy Unit, CHU Limoges, Limoges, France
  • Diane Lorenzo

    1   Department of Digestive Endoscopy, Université Paris Cité, Beaujon University Hospital (APHP), Clichy, France
  • and the ETC Working Group


Graphical Abstract

Preview

Abstract

Background We aimed to determine risk factors for technical failure of endoscopic ultrasound-guided choledochoduodenostomy (EUS-CDS), evaluate short- and long-term consequences, and identify salvage techniques in patients with biliary obstruction.

Methods This retrospective multicenter study of EUS-CDS (2018–2024) included technical failure, classified as type 1 (digestive flange mispositioned), type 2 (biliary flange mispositioned), type 3 (stent deployment failure), type 4 (catheter/lumen-apposing metal stent [LAMS] through the bile duct), and type 5 (others). Controls were successful EUS-CDS in the same center and period. The primary end point was risk factors for failure. Secondary end points were endoscopic rescue techniques and immediate- and long-term consequences.

Results Technical failure occurred in 7 % (95 %CI 5–9). Across 23 centers, 296 patients were analyzed (mean age 71 [SD 16] years, 53 % male), including 100 technical failures: type 1 (26 %), type 2 (41 %), type 3 (11 %), type 4 (6 %), type 5 (16 %). Risk factors for technical failure in multivariate analysis included CBD diameter ≤ 15 mm, duodenal stenosis, wired technique, and low operator experience (≤ 10 LAMS). Endoscopic salvage was successful in 77 %, with 53 % using a covered metal stent and 22 % using a new LAMS. Early failures were mild in 56 % of cases, but 12 % resulted in death within 30 days. Immediate endoscopic salvage reduced severe clinical adverse events (P < 0.001) and increased success rates (P < 0.001).

Conclusions EUS-CDS failures were not rare and were severe in half of cases. Recognizing risk factors, identifying failures during the procedure, and knowing endoscopic salvage methods are crucial.

Supplementary Material



Publication History

Received: 11 June 2024

Accepted after revision: 17 February 2025

Accepted Manuscript online:
17 February 2025

Article published online:
14 May 2025

© 2025. Thieme. All rights reserved.

Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany