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. 2020 Sep;32(6):957-966.
doi: 10.1111/den.13620. Epub 2020 Apr 1.

Risk factor analysis for adverse events and stent dysfunction of endoscopic ultrasound-guided choledochoduodenostomy

Shimpei Matsumoto  1   2 , Kazuo Hara  1 , Nobumasa Mizuno  1 , Takamichi Kuwahara  1 , Nozomi Okuno  1 , Masahiro Obata  1   3 , Yusuke Kurita  1   4 , Hiroki Koda  1 , Masahiro Tajika  5 , Tsutomu Tanaka  5 , Yutaka Hirayama  5 , Sachiyo Onishi  5 , Kazuhiro Toriyama  5 , Yasumasa Niwa  5
Affiliations

Risk factor analysis for adverse events and stent dysfunction of endoscopic ultrasound-guided choledochoduodenostomy

Shimpei Matsumoto et al. Dig Endosc. 2020 Sep.

Abstract

Background and aims: Although the technique of endoscopic ultrasound-guided choledochoduodenostomy (EUS-CDS) is becoming standardized, its safety issues have not been sufficiently investigated. Therefore, we aimed to identify factors associated with adverse events and stent patency in EUS-CDS.

Methods: Consecutive patients who underwent EUS-CDS between September 2003 and July 2017 were included. Technical/clinical success, adverse events and stent dysfunctions were analyzed retrospectively.

Results: A total of 151 patients underwent EUS-CDS. In nine patients, procedures were discontinued before puncture. Technical and clinical success rates were 96.5% (137/142) and 98.5% (135/137), respectively. The adverse event rate was 20.4% (29/142). As a risk factor for peritonitis, plastic stents (PS) showed a significantly high odds ratio (OR) compared with covered self-expandable metal stents (CSEMS; OR, 4.31; P = 0.030). CSEMS cases showed a significantly longer patency period than PS cases (329 vs 89 days; HR, 0.35; P < 0.001). As a risk factor for early stent dysfunction (within 14 days), stent direction to the oral side showed a significantly high OR (OR, 43.47; P < 0.001). In cases with oblique-viewing EUS, double penetration of the duodenum occurred at significantly higher frequency than in cases with forward-viewing EUS (7.0 vs 0.0%; P = 0.024).

Conclusions: Plastic stents and stent direction to the oral side were risk factors for peritonitis and early stent dysfunction, respectively. Using covered self-expandable metal stents and changing stent direction to the anal side seemed appropriate to prevent peritonitis and early stent dysfunction.

Keywords: adverse event; endoscopic ultrasound-guided choledochoduodenostomy; obstructive jaundice; risk factor; stent dysfunction.

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