Temporary placement of a covered duodenal stent can avoid riskier anterograde biliary drainage when ERCP for obstructive jaundice fails due to duodenal invasion.
Duodenal stenosis is one of the most common causes of failed ERCP for obstructive jaundice. Alternative approaches include anterograde biliary drainage, with higher morbidity. We report in this study the efficacy and safety of temporary placement of a covered duodenal self-expandable metal stent (cSEMS) in order to access the papilla and achieve secondary retrograde biliary drainage in patients with obstructive jaundice and failed ERCP due to concomitant duodenal stenosis.



From June 2006 to March 2014, a total of 26 consecutive patients presenting obstructive jaundice without severe sepsis with failed ERCP due to duodenal invasion were enrolled. A temporary 7-day duodenal cSEMS was placed during the failed ERCP, and a second ERCP was attempted at day 7 after duodenal stent removal.



Duodenal cSEMS placement and retrieval were technically successful in all cases. Access to the papilla at day 7 was possible in 25 cases (96 %, 95 % CI 80-99 %). Secondary successful ERCP was achieved in 19 cases (76 %, 95 % CI 55-91 %, i.e., 73 %, 95 % CI 73-86 %, in an intention-to-treat analysis). Mean bilirubin level was 102 ± 90 µmol/L at baseline rising to 164 ± 121 µmol/L at day 7. There were 6 stent migrations and no adverse events recorded between the two ERCPs.



When ERCP for obstructive jaundice fails due to duodenal invasion, temporary cSEMS placement offers a safe and effective way to achieve successful secondary ERCP while avoiding riskier endoscopic ultrasound or percutaneous transhepatic anterograde biliary drainage.
Department of Digestive and Hepatobiliary Diseases, NHE University Hospital of Clermont-Ferrand, 1 place Lucie et Raymond Aubrac, 63003, Clermont-Ferrand, France.|ISIT (Image Sciences for Innovations Techniques), UMR Université d'Auvergne/CNRS 6284, Clermont-Ferrand, France.
Felix
F
Goutorbe
Department of Digestive and Hepatobiliary Diseases, NHE University Hospital of Clermont-Ferrand, 1 place Lucie et Raymond Aubrac, 63003, Clermont-Ferrand, France.
Olivier
O
Rouquette
Biostatistics Unit, DRCI, Gabriel Montpied University Hospital of Clermont-Ferrand, 63003, Clermont-Ferrand, France.
Aurélien
A
Mulliez
Department of Digestive and Hepatobiliary Diseases, NHE University Hospital of Clermont-Ferrand, 1 place Lucie et Raymond Aubrac, 63003, Clermont-Ferrand, France.
Julien
J
Scanzi
Department of Digestive and Hepatobiliary Diseases, NHE University Hospital of Clermont-Ferrand, 1 place Lucie et Raymond Aubrac, 63003, Clermont-Ferrand, France.|Clinical Research Unit, NHE University Hospital of Clermont-Ferrand, 63003, Clermont-Ferrand, France.
Marion
M
Goutte
Department of Digestive and Hepatobiliary Diseases, NHE University Hospital of Clermont-Ferrand, 1 place Lucie et Raymond Aubrac, 63003, Clermont-Ferrand, France.
Michel
M
Dapoigny
Department of Digestive and Hepatobiliary Diseases, NHE University Hospital of Clermont-Ferrand, 1 place Lucie et Raymond Aubrac, 63003, Clermont-Ferrand, France.|ISIT (Image Sciences for Innovations Techniques), UMR Université d'Auvergne/CNRS 6284, Clermont-Ferrand, France.
Armand
A
Abergel
Department of Digestive and Hepatobiliary Diseases, NHE University Hospital of Clermont-Ferrand, 1 place Lucie et Raymond Aubrac, 63003, Clermont-Ferrand, France. lpoincloux@chu-clermontferrand.fr.|ISIT (Image Sciences for Innovations Techniques), UMR Université d'Auvergne/CNRS 6284, Clermont-Ferrand, France. lpoincloux@chu-clermontferrand.fr.
Laurent
0000-0001-6880-9939
L
Poincloux
D000230:Adenocarcinoma / Q000150:complications; D000368:Aged; D000369:Aged, 80 and over; D014670:Ampulla of Vater; D001650:Bile Duct Neoplasms / Q000150:complications; D018281:Cholangiocarcinoma / Q000150:complications; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000379:methods*; D003138:Common Bile Duct Neoplasms / Q000150:complications; D003251:Constriction, Pathologic / Q000209:etiology / Q000601:surgery; D020878:Device Removal; D004322:Drainage / Q000379:methods*; D004378:Duodenal Diseases / Q000209:etiology / Q000601:surgery*; D004379:Duodenal Neoplasms / Q000150:complications; D004384:Duodenoscopy; D004386:Duodenum; D019160:Endosonography; D005260:Female; D006801:Humans; D041781:Jaundice, Obstructive / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000150:complications; D010195:Pancreatitis / Q000150:complications; D012189:Retrospective Studies; D012306:Risk; D000069322:Self Expandable Metallic Stents; D015607:Stents; D017211:Treatment Failure
Duodenal covered SEMS; Duodenal stenosis; EUS-guided biliary drainage; Failed ERCP; Gastric outlet obstruction