Reintervention After Endoscopic Ultrasound-Guided Choledochoduodenostomy for Distal Malignant Biliary Obstruction.

Abstract

Introduction: Studies analyzing the factors associated with reintervention after endoscopic ultrasound (EUS)-guided choledochoduodenostomy (CDS) are limited. We aimed to analyze the incidence and predictors of reintervention in patients with malignant biliary obstruction undergoing EUS-CDS.

Methods: We retrospectively analyzed the data of patients with malignant distal biliary obstruction undergoing EUS-CDS from 8 tertiary care centers in India. The study's primary outcome was reintervention due to stent migration or blockage. The secondary outcomes included clinical success and adverse events. Multivariate analysis using the logistic regression model was used to identify the independent predictors of reintervention.

Results: A total of 134 patients were included in the study. The technical and clinical success rates were 97.8% (131/134) and 93.9% (123/131), respectively. Periprocedural adverse events (AE) were seen in 6% (8/134) cases. Over a median follow-up of 20 weeks, reintervention was required in 8.4% of the cases after a median interval of 11 weeks. On multivariate analysis, cholangitis at presentation (odds ratio [OR] 6.26) and the absence of coaxial stent with concomitant duodenal stent (OR: 7.41) were independent predictors of reintervention in the overall cohort. On subgroup analysis of patients undergoing EUS-CDS with self-expanding metallic stent (SEMS), the absence of a coaxial stent with concomitant duodenal stent (OR: 10.15) was an independent predictor of reintervention.

Conclusion: Reintervention on follow-up after EUS-CDS is required in around 8.4% of cases. The absence of coaxial stent with concomitant duodenal stent was an independent predictor of reintervention in the overall cohort as well as in those undergoing EUS-CDS with SEMS.