title: Multicenter experience with performance of ERCP in patients with an indwelling duodenal stent.
abstract: Endoscopic retrograde cholangiopancreatography (ERCP) in patients with a preexisting duodenal stent covering the papilla is particularly challenging. The aim of this study was to describe a multicenter experience of performing ERCP in patients with biliary obstruction in whom the papilla was obscured by a preexisting duodenal stent. A total of 38 patients with preexisting duodenal stents obscuring the papilla underwent ERCP. Endoscopic biliary cannulation was successful in 13 patients (34.2 %). In 12 of these 13 patients (92.3 %), endoscopic therapy was performed during the same procedure and achieved clinical success with relief of jaundice in all cases (100 %). The most commonly utilized procedure in patients in whom ERCP failed was EUS-guided biliary drainage (EGBD; n = 13 /22, 59.1 %), followed by percutaneous transhepatic biliary drainage (n = 9 /22, 40.9 %). Three patients in whom ERCP failed either did not consent to further intervention or were transferred to other centers. Thus, ERCP was technically challenging in our cohort of patients with preexisting duodenal stents, but was nonetheless successful in about one third of cases. Overall, when performed by experts, endoscopic biliary drainage (via ERCP or EGBD) can be successfully achieved in the majority of patients with indwelling duodenal stents.
authors: Department of Medicine and Division of Gastroenterology and Hepatology, The Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.
authors: Mouen A
authors: MA
authors: Khashab
authors: Department of Medicine and Division of Gastroenterology and Hepatology, The Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.
authors: Ali Kord
authors: AK
authors: Valeshabad
authors: Department of Medicine and Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, Indiana, USA.
authors: Wesley
authors: W
authors: Leung
authors: Division of Gastroenterology and Hepatology, University of Colorado, School of Medicine, Aurora, Colorado, USA.
authors: Joel
authors: J
authors: Camilo
authors: Division of Gastroenterology and Hepatology, University of Colorado, School of Medicine, Aurora, Colorado, USA.
authors: Norio
authors: N
authors: Fukami
authors: Department of Gastroenterology and Nutrition, Geisinger Medical Center, Danville, Pennsylvania, USA.
authors: Frederick
authors: F
authors: Shieh
authors: Department of Gastroenterology and Nutrition, Geisinger Medical Center, Danville, Pennsylvania, USA.
authors: David
authors: D
authors: Diehl
authors: Division of Gastroenterology, Hepatology and Nutrition, University of Minnesota, Minneapolis, Minnesota, USA.
authors: Rajeev
authors: R
authors: Attam
authors: Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands.
authors: Frank P
authors: FP
authors: Vleggaar
authors: Department of Medicine and Division of Gastroenterology and Hepatology, The Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.
authors: Payal
authors: P
authors: Saxena
authors: Division of Gastroenterology, Hepatology and Nutrition, University of Minnesota, Minneapolis, Minnesota, USA.
authors: Martin
authors: M
authors: Freeman
authors: Department of Medicine and Division of Gastroenterology and Hepatology, The Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.
authors: Anthony
authors: A
authors: Kalloo
authors: Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands.
authors: Peter D
authors: PD
authors: Siersema
authors: Department of Medicine and Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, Indiana, USA.
authors: Stuart
authors: S
authors: Sherman
mesh_terms: D000368:Aged; D002760:Cholangiopancreatography, Endoscopic Retrograde; D002779:Cholestasis / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D004322:Drainage / Q000379:methods*; D004380:Duodenal Obstruction / Q000209:etiology / Q000628:therapy; D019160:Endosonography; D005260:Female; D006801:Humans; D041781:Jaundice, Obstructive / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications*; D012189:Retrospective Studies; D015607:Stents; D017211:Treatment Failure; D018084:Ultrasonography, Interventional