Common bile duct size in malignant distal obstruction and lumen-apposing metal stents: a multicenter prospective study

Mihai Rimbaş, Andrea Anderloni, Bertrand Napoléon, Andrada Seicean, Edoardo Forti, Stefano Francesco Crinò, Ilaria Tarantino, Paolo Giorgio Arcidiacono, Carlo Fabbri, Gianenrico Rizzatti, Arnaldo Amato, Theodor Voiosu, Alessandro Fugazza, Ofelia Moșteanu, Àngels Ginès, Germana de Nucci, Pietro Fusaroli, Nam Quoc Nguyen, Roberto Di Mitri, Leonardo Minelli GrazioliMassimiliano Mutignani, Livia Archibugi, Cecilia Binda, Anna Cominardi, Carmelo Barbera, Glòria Fernández-Esparrach, Laurent Palazzo, Maxime Palazzo, Jan Werner Poley, Cristiano Spada, Giorgio Valerii, Takao Itoi, Yukitoshi Matsunami, Radu Bogdan Mateescu, Cristian Băicuș, Guido Costamagna, Alberto Larghi

Research output: Contribution to journalArticlepeer-review


Background and study aims  Feasibility of EUS-guided choledochoduodenostomy (EUS-CDS) using available lumen-apposing stents (LAMS) is limited by the size of the common bile duct (CBD) (≤ 12 mm, cut-off for experts; 15 mm, cut-off for non-experts). We aimed to assess the prevalence and predictive factors associated with CBD size ≥ 12 and 15 mm in naïve patients with malignant distal biliary obstruction (MDBO). Patients and methods  This was a prospective cohort study involving 22 centers with assessment of CBD diameter and subjective feasibility of the EUS-CDS performance in naïve jaundiced patients undergoing EUS evaluation for MDBO. Results  A total of 491 patients (mean age 69 ± 12 years) with mean serum bilirubin of 12.7 ± 6.6 mg/dL entered the final analysis. Dilation of the CBD ≥ 12 and 15 mm was detected in 78.8 % and 51.9 % of cases, respectively. Subjective feasibility of EUS-CDS was expressed by endosonographers in 91.2 % for a CBD ≥ 12 mm and in 96.5 % for a CBD ≥ 15 mm. On multivariate analysis, age ( P  < 0.01) and bilirubin level ( P  ≤ 0.001) were the only factors associated with both CBD dilation ≥ 12 and ≥ 15 mm. These variables were poorly associated with the extent of duct dilation; however, based on them a prediction model could be constructed that satisfactorily predicted CBD size ≥ 12 mm in patients at least 70 years and a bilirubin level ≥ 7 mg/dL. Conclusions  Our study showed that at presentation in a large cohort of patients with MDBO, EUS-CDS can be potentially performed in three quarters to half of cases by expert and less experienced endosonographers, respectively. Dedicated stents or devices with different designs able to overcome the limitations of existing electrocautery-enhanced LAMS for EUS-CDS are needed.

Original languageEnglish
Pages (from-to)E1801-E1810
JournalEndoscopy International Open
Issue number11
Publication statusPublished - Nov 2021


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