Safety and Outcomes of EUS-Guided Choledochoduodenostomy in Patients with a Common Bile Duct Diameter ≤15 mm.
Publication/Presentation Date
11-5-2026
Abstract
BACKGROUND AND AIMS: EUS-guided choledochoduodenostomy (EUS-CDS) using lumen-apposing metal stents (LAMS) is an established biliary drainage strategy after failed ERCP, but deployment in extrahepatic bile ducts (≤15 mm) may increase technical risk. We evaluated outcomes and factors associated with stent misdeployment (SMD), dysfunction, and adverse events in this subgroup.
METHODS: We performed a multicenter retrospective cohort study across 14 tertiary centers of adults undergoing EUS-CDS with cautery-enhanced LAMS in extrahepatic bile ducts ≤15 mm between 2014 and 2025. Prespecified multivariable logistic regression and Kaplan-Meier analyses were performed.
RESULTS: Among 192 patients, 95.3% had malignant biliary obstruction; median bile duct diameter was 14.0 mm (IQR 12.0-14.9). Technical and clinical success were 91.7% and 90.1%, respectively. SMD occurred in 20 patients (10.4%), most commonly type I (80.0%). No lower duct-caliber threshold independently predicted technical failure or SMD. Two-step deployment had a lower unadjusted SMD rate than one-step deployment (3.3% vs 13.7%; P=0.039), but adjusted odds of SMD were lower without reaching statistical significance (aOR 0.25, 95% CI 0.05-1.16; P=0.076). Duodenal obstruction independently predicted stent dysfunction (aOR 2.26, 95% CI 1.02-4.99; P=0.044) and shorter dysfunction-free patency. LAMS ≥8 mm was independently associated with fewer adverse events (aOR 0.42, 95% CI 0.18-0.98; P=0.045).
CONCLUSIONS: EUS-CDS in bile ducts ≤15 mm achieved high technical success but carried an approximately 10% SMD risk. Two-step deployment was associated with fewer observed SMDs, whereas duodenal obstruction predicted later dysfunction. Larger-caliber LAMS was associated with fewer adverse events. These findings warrant prospective validation.
ISSN
1097-6779
Published In/Presented At
Srivastava, R., Wu, C., Fayyaz, F., Roshanshad, R., Gutierrez, O. B., Keane, G., Ichkanian, Y., Marzocca, G., Archibugi, L., Vanella, G., Arcidiacono, P. G., Binda, C., Coluccio, C., Fabbri, C., Donatelli, G., Arevalo-Mora, M., Puga-Tejada, M., Baquerizo, J., Alcivar, J. M., Robles-Medranda, C., … Khashab, M. A. (2026). Safety and Outcomes of EUS-Guided Choledochoduodenostomy in Patients with a Common Bile Duct Diameter ≤15 mm. Gastrointestinal endoscopy, S0016-5107(26)07172-5. Advance online publication. https://doi.org/10.1016/j.gie.2026.10.030
Disciplines
Business Administration, Management, and Operations | Health and Medical Administration | Management Sciences and Quantitative Methods
PubMedID
42988125
Department(s)
Administration and Leadership
Document Type
Article