Technical failure of endoscopic ultrasound choledocoduodenostomy: Multicenter case-control study on rescue techniques, consequences and risk factors

Clara Beunon; Antoine Debourdeau; Marion Schaefer; Timothee Wallenhorst; Enrique Perez-Cuadrado-Robles; Arthur Belle; Jean-Michel Gonzalez; Marine Camus Duboc; Fabrice Caillol; Hervé-Pierre Toudic; Mathieu Pioche; Jean Baptiste Danset; Adrien Sportes; Bertrand Brieau; Emmanuel Ben Soussan; Mathilde Petiet; Antoine Martin; Sarra Oumrani; Frederique Maire; Arnaud Lemmers; Frederic Prat; Ludovic Caillo; Romain Gerard; Jérémie Albouys; Diane Lorenzo

doi:10.1055/a-2541-2973

Endoscopy, Table of Contents

Endoscopy
DOI: 10.1055/a-2541-2973

Original article

Technical failure of endoscopic ultrasound choledocoduodenostomy: Multicenter case-control study on rescue techniques, consequences and risk factors

Clara Beunon

¹Endoscopy, Hopital Beaujon, Clichy, France (Ringgold ID: RIN55100)

,

Antoine Debourdeau

²Gastroenterology and Liver Transplantation Unit,, Centre Hospitalier Regional Universitaire de Montpellier, Montpellier, France (Ringgold ID: RIN26905)

,

Marion Schaefer

³Hepato-Gastroenterology Departement, Nancy Regional University Hospital Center, Nancy, France (Ringgold ID: RIN26920)

,

Timothee Wallenhorst

⁴Department of Endoscopy and Gastroenterology, University Hospital Centre Rennes, Rennes, France (Ringgold ID: RIN36684)

,

Enrique Perez-Cuadrado-Robles

⁵Department of gastroenterology, hopital Européen Georges Pompidou, Paris, France, Universite Paris Cite, Paris, France (Ringgold ID: RIN555089)

,

Arthur Belle

⁶Gastroenterology Department, Cochin University Hospital, Assistance Publique-Hôpitaux de Paris and University of Paris, France, paris, France

,

Jean-Michel Gonzalez

⁷Gastroenterology, Hopital Nord, Marseille, France

,

Marine Camus Duboc

⁸Endoscopy, Sorbonne University, Paris, France (Ringgold ID: RIN27063)

,

Fabrice Caillol

⁹Digestive Endoscopy Unit, Paoli-Calmettes Institute, Marseille, France (Ringgold ID: RIN56181)

,

Hervé-Pierre Toudic

¹⁰Gastroenterology Department, University and Regional Hospital Centre Brest, Brest, France (Ringgold ID: RIN26990)

,

Mathieu Pioche

¹¹Gastroenterology, Edouard Herriot Hospital, Lyon, France

,

Jean Baptiste Danset

¹²Gastroenterology, Fondation Hopital Saint Joseph, Paris, France (Ringgold ID: RIN55662)

,

Adrien Sportes

¹³Gastroenterology, Institut Arnault Tzanck, Saint-Laurent du Var, France (Ringgold ID: RIN56572)

,

Bertrand Brieau

¹⁴Gastroenterology and endoscopy unit, Clinique Jules Verne, Nantes, France (Ringgold ID: RIN84352)

,

Emmanuel Ben Soussan

¹⁵ile de france, Clinique de l’Alma, Paris, France

,

Mathilde Petiet

¹⁶77, Grand hôpital de l'est francilien, Meaux, France

,

Antoine Martin

¹⁷Gastroenterology Unit, Hospital Bicetre Department of Hepato-Gastroenterology, Le Kremlin-Bicetre, France (Ringgold ID: RIN568566)

,

Sarra Oumrani

¹⁸Hepatology and Gastroenterology, Lausanne University Hospital, Lausanne, Switzerland (Ringgold ID: RIN30635)

,

Frederique Maire

¹⁹Département d'endoscopie digestive, Hôpital Beaujon, Clichy, France (Ringgold ID: RIN55100)

,

Arnaud Lemmers

²⁰Gastroenterology, Hepatopancreatology and Digestive Oncology, Hopital Erasme, Bruxelles, Belgium (Ringgold ID: RIN70496)

,

Frederic Prat

²¹Gastroenterology, Cochin Hospital, Paris, France

,

Ludovic Caillo

²²Gastroenterology, Centre Hospitalier Universitaire de Nimes, Nimes, France (Ringgold ID: RIN36672)

,

Romain Gerard

²³Gastroenterology, CHRU de Lille, Lille, France (Ringgold ID: RIN26902)

,

Jérémie Albouys

²⁴hepato-gastro-entérologie, Hopital Dupuytren, Limoges, France (Ringgold ID: RIN37925)

,

Diane Lorenzo

²⁵Endoscopy unit, Hopital Beaujon, Clichy, France (Ringgold ID: RIN55100)

› Author Affiliations

Abstract

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Background and study aims We aimed to identify risk factors and salvage technique for technical failures of endoscopic ultrasound-guided choledochoduodenostomy (EUS-CDS) and evaluate the short and long-term consequences in patients with biliary obstruction. Patients and methods This retrospective multicenter study included EUS-CDS from 2018 to 2024. Cases were defined as technical failure and classified as follow: type1 (digestive-flange mispositioned), type2 (biliary-flange mispositioned), type3 (stent deployment failure), type4 (catheter-LAMS through the bile duct), and type5 (others). Controls were successful EUS-CDS in the same center and period. The primary endpoint was to to identify risk factors for failure. Secondary endpoints were to describe the endoscopic rescue techniques to evaluate immediate and long-term consequences. Results Technical failures occurred in 7% (95%CI[5;9]). In 23 centers, 296 patients were included (53% male, 71±16 years): 100 cases (type1 [26%], type2 [41%], type3 [11%], type4 [6%], and type5 [16%]) and 196 controls. Risk factors in multivariate analysis for technical failures included CBD diameter ≤15mm, duodenal stenosis, Wired technique and low operator experience (≤10 LAMS). Endoscopic salvage was successful in 77% of cases, with 53% using a covered metal stent and 22% using a new LAMS. Early failures were mild in 50% of cases, but 12% resulted in death within 30 days. Immediate endoscopic salvage reduced severe clinical adverse event (p<0.00001) and increased success rates (p<0.0004). Conclusions EUS-CDS failures are not rare and are severe in half of the cases. Recognizing risk factors, identifying failures during the procedure, and knowing endoscopic salvage methods are crucial.

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