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

Autor:	Chen YI; Division of Gastroenterology and Hepatology, McGill University Health Centre, Montreal, Quebec, Canada., Long C; Division of Gastroenterology and Hepatology, McGill University Health Centre, Montreal, Quebec, Canada., Sahai AV; Service de Gastroentérologie, Centre Hospitalier de l'Université de Montréal, Montréal, Quebec, Canada., Napoleon B; Hopital Privé Jean Mermoz, Ramsay Santé, Lyon, France., Donatelli G; Unité d'Endoscopie Interventionnelle, Hôpital Privé des Peupliers, Paris, France., Kunda R; Department of Surgery, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium.; Department of Gastroenterology-Hepatology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium.; Department of Advanced Interventional Endoscopy, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium.; Department of Surgical Gastroenterology, Aarhus University Hospital, Aarhus, Denmark., Martel M; Division of Gastroenterology and Hepatology, McGill University Health Centre, Montreal, Quebec, Canada., Chan SM; Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China., Arcidiacono PG; Pancreato-Biliary Endoscopy and Endosonography Division, Pancreas Translational and Clinical Research Center, San Raffaele Scientific Institute IRCCS, Vita Salute San Raffaele University, Milan, Italy., Lam E; Division of Gastroenterology and Hepatology, St-Paul Hospital, Vancouver, British Columbia, Canada., Kongkam P; 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., Forbes N; Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Alberta, Canada., Larghi A; Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy., Mosko JD; Division of Gastroenterology, St-Michael's Hospital, University of Toronto, Toronto, Ontario, Canada., Van der Merwe S; Department of Gastroenterology and Hepatology, The University of Leuven, Leuven, Belgium., Gan SI; Division of Gastroenterology and Hepatology, Vancouver General Hospital, Vancouver, British Columbia, Canada., Jacques J; Gastroenterology Department, Dupuytren University Hospital, Limoges, France., Kenshil S; Division of Gastroenterology and Hepatology, Ottawa Hospital, Ottawa, Ontario, Canada., Ratanachu-Ek T; Department of Surgery, Rajavithi Hospital, Bangkok, Thailand., Miller C; Division of Gastroenterology and Hepatology, Jewish General Hospital, Montreal, Quebec, Canada., Saxena P; Department of Gastroenterology, Royal Prince Alfred Hospital, Sidney, Australia., Desilets E; Division of Gastroenterology, Hôpital Charles-Le Moyne, Longeuil, Quebec, Canada., Sandha G; Division of Gastroenterology and Hepatology, University of Alberta Hospital, Edmonton, Alberta, Canada., Alrifae Y; Division of Gastroenterology and Hepatology, McGill University Health Centre, Montreal, Quebec, Canada., Teoh AYB; Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China.
Jazyk:	angličtina
Zdroj:	Endoscopy [Endoscopy] 2024 Dec 16. Date of Electronic Publication: 2024 Dec 16.
DOI:	10.1055/a-2463-1601
Abstrakt:	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. Competing Interests: Y.I. Chen is a consultant for Boston Scientific, has received research funding from Boston Scientific, and is the co-founder of Chess Medical Inc. A. Sahai is a consultant for Boston Scientific and Pentax. B. Napoleon has received honoraria for proctoring endoscopy training from Maunea Kea, Boston Scientific, Olympus, and TaeWoong Medical. R. Kunda is a consultant for Boston Scientific, Olympus, M.I.Tech, Omega Medical Imaging, Q3 Medical-AMG International, and EndoGastric Solutions. N. Forbes is a consultant and speaker for Boston Scientific and Pentax Medical, a speaker for AstraZeneca, and has received research funding from Pentax Medical. A.Y.B. Teoh is a consultant for Boston Scientific, Cook, TaeWoong Medical, Microtech, and M.I.Tech. The remaining authors declare that they have no conflict of interest. (Thieme. All rights reserved.)
Databáze:	MEDLINE
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