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Surgical Endoscopy
Published in: Surgical Endoscopy 2/2017

01-02-2017

Temporary placement of a covered duodenal stent can avoid riskier anterograde biliary drainage when ERCP for obstructive jaundice fails due to duodenal invasion

Authors: Felix Goutorbe, Olivier Rouquette, Aurélien Mulliez, Julien Scanzi, Marion Goutte, Michel Dapoigny, Armand Abergel, Laurent Poincloux

Published in: Surgical Endoscopy | Issue 2/2017

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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.
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Metadata
Title
Temporary placement of a covered duodenal stent can avoid riskier anterograde biliary drainage when ERCP for obstructive jaundice fails due to duodenal invasion
Authors
Felix Goutorbe
Olivier Rouquette
Aurélien Mulliez
Julien Scanzi
Marion Goutte
Michel Dapoigny
Armand Abergel
Laurent Poincloux
Publication date
01-02-2017
Publisher
Springer US
Published in
Surgical Endoscopy / Issue 2/2017
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-016-5008-5

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