title: Temporary duodenal stenting as a bridge to ERCP for inaccessible papilla due to duodenal obstruction: a retrospective study.
abstract: OBJECTIVE
  Duodenal obstruction may prevent performance of endoscopic retrograde cholangiopancreatography (ERCP). Percutaneous transhepatic biliary drainage (PTBD) or Endoscopic ultrasonograhy-guided biliary access (EUS-BD) are alternative treatments but are associated with a higher morbidity and mortality rate. The aim of the study is to report overall technical success rate and clinical outcome with deployment of temporary fully or partially covered self-expanding duodenal stent (pc/fcSEMS) as a bridge to ERCP in case of inaccessible papilla due to duodenal strictures.
  
  
  METHODS
  This retrospective study included 66 consecutive patients presenting with a duodenal stricture impeding the ability to perform an ERCP. Provisional duodenal stenting was performed as a bridge to ERCP. A second endoscopic session was performed to remove the provisional stent and to perform an ERCP. Afterward, a permanent duodenal stent was delivered if necessary.
  
  
  RESULTS
  Sixty-six duodenal stents (17 pcSEMS and 49 fcSEMS) were delivered with a median indwelling time of 3.15 (1 - 7) days. Two migrations occurred in the pcSEMS group, 1 of which required lower endoscopy for retrieval. No other procedure-related complications were observed. At second endoscopy a successful ERCP was performed in 56 patients (85 %); 10 patients (15 %) with endoscopic failure underwent PTBD or EUS-BD. Forty patients needed permanent duodenal stenting.
  
  
  CONCLUSIONS
  Provisional removable covered duodenal stenting as a bridge to ERCP for duodenal obstruction is safe procedure and in most cases allows successful performance of therapeutic ERCP. This technique could be a sound option as a step up approach before referring such cases for more complex techniques such as EUS-BD or PTBD.
authors.affiliation: Unité d'Endoscopie Interventionnelle, Ramsay Générale de Santé, Hôpital Privé des Peupliers, Paris, France.
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Donatelli
authors.affiliation: Unit of Interventional Endoscopy, Department of General Surgery "P. Stefanini", "Sapienza" University of Rome, Rome, Italy.
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Cereatti
authors.affiliation: Unité d'Endoscopie Interventionnelle, Ramsay Générale de Santé, Hôpital Privé des Peupliers, Paris, France.
authors.forename: Jean-Loup
authors.initials: JL
authors.lastname: Dumont
authors.affiliation: Department of General and Laparoscopic Surgery, Lilavati Hospital and Research Center, Bandra(w), Mumbai, India.
authors.forename: Parag
authors.initials: P
authors.lastname: Dhumane
authors.affiliation: Unité d'Endoscopie Interventionnelle, Ramsay Générale de Santé, Hôpital Privé des Peupliers, Paris, France.
authors.forename: Thierry
authors.initials: T
authors.lastname: Tuszynski
authors.affiliation: Unité de Radiologie Interventionnelle, Ramsay Générale de Santé, Hôpital Privé des Peupliers, Paris, France.
authors.forename: Serge
authors.initials: S
authors.lastname: Derhy
authors.affiliation: Unité d'Endoscopie Interventionnelle, Ramsay Générale de Santé, Hôpital Privé des Peupliers, Paris, France.
authors.forename: Alexandre
authors.initials: A
authors.lastname: Meduri
authors.affiliation: Unité d'Endoscopie Interventionnelle, Ramsay Générale de Santé, Hôpital Privé des Peupliers, Paris, France.
authors.forename: Bertrand Marie
authors.initials: BM
authors.lastname: Vergeau
authors.affiliation: Unité d'Endoscopie Interventionnelle, Ramsay Générale de Santé, Hôpital Privé des Peupliers, Paris, France.
authors.forename: Bruno
authors.initials: B
authors.lastname: Meduri