title: Biliary stenting is not a prerequisite to endoscopic placement of duodenal covered self-expandable metal stents.
abstract: BACKGROUND
  Duodenal covered self-expandable metal stent (cSEMS) can be used in malignant or benign gastroduodenal obstruction. The need for biliary stenting in patients with no concomitant biliary stricture, before duodenal cSEMS placement, remains unknown. The aim of this study was to determine whether cSEMS placement is responsible for biliary obstruction.
  
  
  METHODS
  This is a single-center, retrospective, case-controlled study, including 106 patients with symptomatic gastric outlet obstruction or duodenal fistula who received a covered nitinol duodenal stent by using through-the-scope/over-the-wire placement procedure. The main outcome measurement was the occurrence comparison of jaundice and bilirubin level, between patients with previous or concomitant biliary stenting (cSEMS + BS group), and patients with no biliary stent (cSEMS group) during an observational period of 90 days.
  
  
  RESULTS
  Hundred and six patients underwent cSEMS placement between June 2005 and March 2014: 53 in the cSEMS group (58% male, mean age 66.4 ± 13.3 years) and 53 in cSEMS + BS group (60% male, mean age 70.4 ± 11.6 years). The obstruction was due to cancer in 45% in cSEMS group and 87% in cSEMS + BS group. No case of jaundice was reported in the cSEMS group or in the cSEMS + BS group. In cSEMS group, the mean bilirubin level (μmol/L ± SD) was 8.0 ± 4 at baseline and 8.5 ± 4.6 at day 10, while in the cSEMS + BS group it was 91.4 ± 108 at baseline and 35.3 ± 39 at day 10 (p < 0.01). Patients from the two groups were matched on age, gender and bilirubin level at baseline. Evolution of bilirubinemia was +0.98 ± 2.76 µmol/L in experimental group and +0.39 ± 522 µmol/L in the control group (p = 0.34). No significant difference was observed between the two groups in term of technical success, clinical effectiveness, migration and other complications.
  
  
  CONCLUSIONS
  Previous biliary stenting is not required before endoscopic covered duodenal stent placement in patients with no associated biliary obstruction. Prospective studies are needed.
authors.affiliation: Digestive Diseases Department, NHE University Hospital of Clermont-Ferrand, 63003, Clermont-Ferrand, France. lpoincloux@chu-clermontferrand.fr.|ISIT (Image Sciences for Innovations Techniques), UMR Auvergne University/CNRS 6284, Clermont-Ferrand, France. lpoincloux@chu-clermontferrand.fr.
authors.forename: L
authors.initials: L
authors.lastname: Poincloux
authors.affiliation: Digestive Diseases Department, NHE University Hospital of Clermont-Ferrand, 63003, Clermont-Ferrand, France.
authors.forename: F
authors.initials: F
authors.lastname: Goutorbe
authors.affiliation: Digestive Diseases Department, NHE University Hospital of Clermont-Ferrand, 63003, Clermont-Ferrand, France.
authors.forename: O
authors.initials: O
authors.lastname: Rouquette
authors.affiliation: Biostatistics Unit, DRCI, Gabriel Montpied University Hospital of Clermont-Ferrand, 63003, Clermont-Ferrand, France.
authors.forename: A
authors.initials: A
authors.lastname: Mulliez
authors.affiliation: Clinical Research Unit, NHE University Hospital of Clermont-Ferrand, 63003, Clermont-Ferrand, France.
authors.forename: M
authors.initials: M
authors.lastname: Goutte
authors.affiliation: Digestive Diseases Department, NHE University Hospital of Clermont-Ferrand, 63003, Clermont-Ferrand, France.
authors.forename: G
authors.initials: G
authors.lastname: Bommelaer
authors.affiliation: Digestive Diseases Department, NHE University Hospital of Clermont-Ferrand, 63003, Clermont-Ferrand, France.|ISIT (Image Sciences for Innovations Techniques), UMR Auvergne University/CNRS 6284, Clermont-Ferrand, France.
authors.forename: A
authors.initials: A
authors.lastname: Abergel
mesh_terms: D000368:Aged; D001660:Biliary Tract Diseases / Q000601:surgery*; D001662:Biliary Tract Surgical Procedures / Q000009:adverse effects*; D004380:Duodenal Obstruction / Q000150:complications* / Q000601:surgery; D004384:Duodenoscopy; D005260:Female; D006801:Humans; D041781:Jaundice, Obstructive / Q000209:etiology* / Q000601:surgery; D008297:Male; D019919:Prosthesis Implantation / Q000009:adverse effects; D012189:Retrospective Studies; D000069322:Self Expandable Metallic Stents; D016896:Treatment Outcome
keywords: Biliary adverse events; Biliary stent; Covered duodenal stent; Duodenal fistula; Gastric outlet obstruction; Jaundice