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Risk factor analysis for adverse events and stent dysfunction of endoscopic ultrasound‐guided choledochoduodenostomy
Author(s) -
Matsumoto Shimpei,
Hara Kazuo,
Mizuno Nobumasa,
Kuwahara Takamichi,
Okuno Nozomi,
Obata Masahiro,
Kurita Yusuke,
Koda Hiroki,
Tajika Masahiro,
Tanaka Tsutomu,
Hirayama Yutaka,
Onishi Sachiyo,
Toriyama Kazuhiro,
Niwa Yasumasa
Publication year - 2020
Publication title -
digestive endoscopy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.5
H-Index - 56
eISSN - 1443-1661
pISSN - 0915-5635
DOI - 10.1111/den.13620
Subject(s) - medicine , stent , adverse effect , odds ratio , surgery , peritonitis , radiology , endoscopic ultrasound
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.