From the Guidelines
The complication rate after EUS-guided choledochoduodenostomy is approximately 20.4%, with a mortality rate of 3.9%, as reported in the most recent study 1. The complications associated with this procedure include stent dislodgement, stent blockage, leak, peritonitis, pneumoperitoneum, abdominal abscess, and recurrent cholecystitis. Some key factors that may influence the complication rate include:
- Technical factors, such as the use of dedicated lumen-apposing metal stents (LAMS) and proper stent deployment
- Patient selection, with higher complication rates observed in patients with altered anatomy, severe coagulopathy, or very small bile ducts
- The experience and skill of the endoscopist performing the procedure, as well as the volume of procedures performed at the center Post-procedure care is crucial to minimize the risk of complications, and should include close monitoring for signs of peritonitis, bleeding, or infection, as well as prophylactic antibiotics and observation for at least 24-48 hours after the procedure. It's worth noting that while the complication rate may seem high, EUS-guided choledochoduodenostomy is still a viable alternative to percutaneous drainage or surgical bypass in patients with malignant biliary obstruction when ERCP is not feasible, especially considering the decreasing complication rates over time due to improvements in technique and devices 1.
From the Research
Complication Rate After EUS Guided Choledochoduodenostomy
- The complication rate after EUS guided choledochoduodenostomy varies across studies, with early complications encountered in 17% of patients in one study 2.
- A retrospective analysis of EUS-CDS procedures performed in France reported short-term complications in 3.8% of patients 3.
- Another study reported an overall major procedural complication rate of 7%, including duodenal perforations, bleeding, and transient cholangitis 4.
- A nationwide analysis in Italy reported adverse events in 10.5% of patients, with no fatal adverse events 5.
- A multicenter cohort study comparing EUS-guided choledochoduodenostomy and percutaneous drainage reported a trend toward lower rates of adverse events with EUS-CD (14.3% vs 29.3%) 6.
Types of Complications
- Focal peritonitis 2
- Hemobilia 2
- Duodenal perforation 4
- Bleeding 4
- Transient cholangitis 4
- Stent migration 4
- Sump syndrome with transient increase in serum bilirubin concentrations with sludge in the distal duct reservoir 4