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Surgical Endoscopy

, Volume 31, Issue 2, pp 625–631 | Cite as

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

  • Felix Goutorbe
  • Olivier Rouquette
  • Aurélien Mulliez
  • Julien Scanzi
  • Marion Goutte
  • Michel Dapoigny
  • Armand Abergel
  • Laurent PoinclouxEmail author
Article

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.

Keywords

Duodenal covered SEMS Duodenal stenosis Failed ERCP Gastric outlet obstruction EUS-guided biliary drainage 

Notes

Compliance with ethical standards

Conflict of interest

Felix Goutorbe, Olivier Rouquette, Aurélien Mulliez, Julien Scanzi, Marion Goutte, Michel Dapoigny, Armand Abergel, Laurent Poincloux have no conflicts of interest to declare.

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Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  1. 1.Department of Digestive and Hepatobiliary DiseasesNHE University Hospital of Clermont-FerrandClermont-FerrandFrance
  2. 2.Biostatistics Unit, DRCIGabriel Montpied University Hospital of Clermont-FerrandClermont-FerrandFrance
  3. 3.Clinical Research UnitNHE University Hospital of Clermont-FerrandClermont-FerrandFrance
  4. 4.ISIT (Image Sciences for Innovations Techniques)UMR Université d’Auvergne/CNRS 6284Clermont-FerrandFrance

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