Yen-I Chen, Clara Long, Anand V Sahai, Bertrand Napoleon, Gianfranco Donatelli, Rastislav Kunda, Myriam Martel, Shannon M Chan, Paolo G Arcidiacono, Eric Lam, Pradermchai Kongkam, Nauzer Forbes, Alberto Larghi, Jeffrey D Mosko, Schalk Van der Merwe, Seng Ian Gan, Jeremie Jacques, Sana Kenshil, Thawee Ratanachu-Ek, Corey Miller, Payal Saxena, Etienne Desilets, Gurpal Sandha, Yousef Alrifae, Anthony Y B Teoh
{"title":"EUS引导下胆总管十二指肠造口术中的支架错置和失败相关因素:对ELEMENT和DRA-MBO试验合并数据集的分析。","authors":"Yen-I Chen, Clara Long, Anand V Sahai, Bertrand Napoleon, Gianfranco Donatelli, Rastislav Kunda, Myriam Martel, Shannon M Chan, Paolo G Arcidiacono, Eric Lam, Pradermchai Kongkam, Nauzer Forbes, Alberto Larghi, Jeffrey D Mosko, Schalk Van der Merwe, Seng Ian Gan, Jeremie Jacques, Sana Kenshil, Thawee Ratanachu-Ek, Corey Miller, Payal Saxena, Etienne Desilets, Gurpal Sandha, Yousef Alrifae, Anthony Y B Teoh","doi":"10.1055/a-2463-1601","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong> 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.</p><p><strong>Method: </strong> 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.</p><p><strong>Results: </strong> 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.</p><p><strong>Conclusion: </strong> 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.</p>","PeriodicalId":11516,"journal":{"name":"Endoscopy","volume":" ","pages":""},"PeriodicalIF":11.5000,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Stent misdeployment and factors associated with failure in endoscopic ultrasound-guided choledochoduodenostomy: analysis of the combined datasets from two randomized trials.\",\"authors\":\"Yen-I Chen, Clara Long, Anand V Sahai, Bertrand Napoleon, Gianfranco Donatelli, Rastislav Kunda, Myriam Martel, Shannon M Chan, Paolo G Arcidiacono, Eric Lam, Pradermchai Kongkam, Nauzer Forbes, Alberto Larghi, Jeffrey D Mosko, Schalk Van der Merwe, Seng Ian Gan, Jeremie Jacques, Sana Kenshil, Thawee Ratanachu-Ek, Corey Miller, Payal Saxena, Etienne Desilets, Gurpal Sandha, Yousef Alrifae, Anthony Y B Teoh\",\"doi\":\"10.1055/a-2463-1601\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong> 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.</p><p><strong>Method: </strong> 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.</p><p><strong>Results: </strong> 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.</p><p><strong>Conclusion: </strong> 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.</p>\",\"PeriodicalId\":11516,\"journal\":{\"name\":\"Endoscopy\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":11.5000,\"publicationDate\":\"2024-12-16\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Endoscopy\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1055/a-2463-1601\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"GASTROENTEROLOGY & HEPATOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Endoscopy","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1055/a-2463-1601","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"GASTROENTEROLOGY & HEPATOLOGY","Score":null,"Total":0}
Stent misdeployment and factors associated with failure in endoscopic ultrasound-guided choledochoduodenostomy: analysis of the combined datasets from two randomized trials.
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.
期刊介绍:
Endoscopy is a leading journal covering the latest technologies and global advancements in gastrointestinal endoscopy. With guidance from an international editorial board, it delivers high-quality content catering to the needs of endoscopists, surgeons, clinicians, and researchers worldwide. Publishing 12 issues each year, Endoscopy offers top-quality review articles, original contributions, prospective studies, surveys of diagnostic and therapeutic advances, and comprehensive coverage of key national and international meetings. Additionally, articles often include supplementary online video content.