Beunon Clara, Debourdeau Antoine, Schaefer Marion, Wallenhorst Timothée, Perez-Cuadrado-Robles Enrique, Belle Arthur, Gonzalez Jean-Michel, Camus Duboc Marine, Caillol Fabrice, Toudic Hervé-Pierre, Pioche Mathieu, Danset Jean Baptiste, Sportes Adrien, Brieau Bertrand, Ben Soussan Emmanuel, Petiet Mathilde, Martin Antoine, Oumrani Sarra, Maire Frédérique, Lemmers Arnaud, Prat Frédéric, Caillo Ludovic, Gérard Romain, Albouys Jérémie, Lorenzo Diane
Department of Digestive Endoscopy, Université Paris Cité, Beaujon University Hospital (APHP), Clichy, France.
Department of Pancreatology and Digestive Oncology, Université Paris Cité, Beaujon University Hospital (APHP), CRMR PaRaDis Pancreatic Rare Diseases, Clichy, France.
Endoscopy. 2025 Sep;57(9):990-1000. doi: 10.1055/a-2541-2973. Epub 2025 Feb 17.
We aimed to determine risk factors for technical failure of endoscopic ultrasound-guided choledochoduodenostomy (EUS-CDS), evaluate short- and long-term consequences, and identify salvage techniques in patients with biliary obstruction.
This retrospective multicenter study of EUS-CDS (2018-2024) included technical failure, classified as type 1 (digestive flange mispositioned), type 2 (biliary flange mispositioned), type 3 (stent deployment failure), type 4 (catheter/lumen-apposing metal stent [LAMS] through the bile duct), and type 5 (others). Controls were successful EUS-CDS in the same center and period. The primary end point was risk factors for failure. Secondary end points were endoscopic rescue techniques and immediate- and long-term consequences.
Technical failure occurred in 7 % (95 %CI 5-9). Across 23 centers, 296 patients were analyzed (mean age 71 [SD 16] years, 53 % male), including 100 technical failures: type 1 (26 %), type 2 (41 %), type 3 (11 %), type 4 (6 %), type 5 (16 %). Risk factors for technical failure in multivariate analysis included CBD diameter ≤ 15 mm, duodenal stenosis, wired technique, and low operator experience (≤ 10 LAMS). Endoscopic salvage was successful in 77 %, with 53 % using a covered metal stent and 22 % using a new LAMS. Early failures were mild in 56 % of cases, but 12 % resulted in death within 30 days. Immediate endoscopic salvage reduced severe clinical adverse events ( < 0.001) and increased success rates ( < 0.001).
EUS-CDS failures were not rare and were severe in half of cases. Recognizing risk factors, identifying failures during the procedure, and knowing endoscopic salvage methods are crucial.
我们旨在确定内镜超声引导下胆总管十二指肠吻合术（EUS-CDS）技术失败的危险因素，评估短期和长期后果，并确定胆道梗阻患者的补救技术。
这项对EUS-CDS（2018 - 2024年）的回顾性多中心研究包括技术失败，分为1型（消化端凸缘位置错误）、2型（胆管端凸缘位置错误）、3型（支架置入失败）、4型（导管/管腔贴壁金属支架[LAMS]穿过胆管）和5型（其他）。对照组为同一中心和时期内成功的EUS-CDS。主要终点是失败的危险因素。次要终点是内镜补救技术以及近期和长期后果。
技术失败发生率为7%（95%CI 5 - 9）。在23个中心，共分析了296例患者（平均年龄71[标准差16]岁，53%为男性），其中100例技术失败：1型（26%），2型（41%），3型（11%），4型（6%），5型（16%）。多因素分析中技术失败的危险因素包括胆总管直径≤15mm、十二指肠狭窄、有线技术以及术者经验不足（≤10例LAMS）。内镜补救成功率为77%，其中53%使用覆膜金属支架，22%使用新型LAMS。早期失败病例中56%症状较轻，但12%在30天内死亡。立即进行内镜补救可减少严重临床不良事件（<0.001）并提高成功率（<0.001）。
EUS-CDS失败并不罕见，半数病例后果严重。识别危险因素、术中识别失败情况以及了解内镜补救方法至关重要。
