Felix Goutorbe1,2, Olivier Rouquette1, Aurélien Mulliez3, Julien Scanzi1, Marion Goutte1,4, Michel Dapoigny1, Armand Abergel1,2, Laurent Poincloux5,6. 1. Department of Digestive and Hepatobiliary Diseases, NHE University Hospital of Clermont-Ferrand, 1 place Lucie et Raymond Aubrac, 63003, Clermont-Ferrand, France. 2. ISIT (Image Sciences for Innovations Techniques), UMR Université d'Auvergne/CNRS 6284, Clermont-Ferrand, France. 3. Biostatistics Unit, DRCI, Gabriel Montpied University Hospital of Clermont-Ferrand, 63003, Clermont-Ferrand, France. 4. Clinical Research Unit, NHE University Hospital of Clermont-Ferrand, 63003, Clermont-Ferrand, France. 5. 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. 6. ISIT (Image Sciences for Innovations Techniques), UMR Université d'Auvergne/CNRS 6284, Clermont-Ferrand, France. lpoincloux@chu-clermontferrand.fr.
Abstract
BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.
BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.
Authors: Bart J M Leenders; Arnold Stronkhorst; Frans J Smulders; Grard A Nieuwenhuijzen; Lennard P L Gilissen Journal: Surg Endosc Date: 2013-02-23 Impact factor: 4.584
Authors: Oliver Waidmann; Jörg Trojan; Mireen Friedrich-Rust; Christoph Sarrazin; Wolf Otto Bechstein; Frank Ulrich; Stefan Zeuzem; Jörg Gerhard Albert Journal: World J Gastroenterol Date: 2013-10-07 Impact factor: 5.742
Authors: Sun Mi Lee; Dae Hwan Kang; Gwang Ha Kim; Won Il Park; Hyong Wook Kim; Jin Hong Park Journal: Gastrointest Endosc Date: 2007-10-29 Impact factor: 9.427