Aims In case of distal malignant biliary obstructions, when ERCP (endoscopic retrograde
cholangiopancreatography) fails, drainage via EUS-CDS (endoscopic ultrasound-guided
choledochoduodenostomy) using LAMS (lumen-apposing metal stent) has become the gold
standard. The data regarding stent obstruction during follow-up are heterogeneous
and range from 9 to 55%1. Identified risk factors include the presence of a duodenal stent2, duodenal invasion3, and a bile duct diameter<15mm2. The objective of our study is to identify risk factors for stent obstruction, evaluate
the efficacy of obstruction management, and define the best strategy for managing
these stent obstructions.
Methods We conducted a retrospective study of a monocentric prospective database, including
all patients treated with EUS-CDS for distal biliary obstruction between 2017 and
2024 in a French university hospital. Obstruction was defined as persistent and/or
recurrent jaundice and/or acute cholangitis during follow-up.
Results A total of 168 patients were included in our study. The overall stent correct function
rate was 72%, with a mean follow-up of 176 days (5.8 months) [1]
[2]
[3]. We confirmed that gastrointestinal obstruction was a risk factor for stent obstruction
in both univariate analysis (OR=4.22 [1.91; 9.31], p=0.001) and multivariate analysis
(OR=4.67 [2.05; 10.65], p=0.0002). Regarding the best management strategy for stent
obstruction, placing a new pig-tail or metallic stent within the lumen-apposing stent
is more effective than simple mechanical desobstruction or antibiotic therapy alone.
There was a a higher rate of biliary event-free survival during follow-up (at 6 months
92.3% versus 58.9%; at 12 months 80.8% versus 47.1%).
Conclusions We confirm that gastrointestinal obstruction is a risk factor for stent obstruction
in EUS-CDS procedures. In cases of cholangitis or persistent jaundice, endoscopic
desobstruction by placing a new pig-tail or metallic stent is more effective than
simple desobstruction or antibiotic therapy.
