Objectives: The aim of this study was to compare endoscopic ultrasound‐guided choledochoduodenostomy (EUS‐CDS) vs. EUS‐gallbladder drainage (EUS‐GBD) in cases of failed endoscopic retrograde cholangiopancreatography (ERCP) for jaundice resulting from malignant distal biliary obstruction (MDBO).Methods: This multicenter retrospective study included patients with obstructive jaundice secondary to MDBO who underwent EUS‐GBD or EUS‐CDS with lumen‐apposing metal stents after failed ERCP. The primary end‐point was clinical success rate. Secondary end‐points were technical success, periprocedural adverse events rate (24 h), overall survival, and time to recurrent biliary obstruction.Results: A total of 78 patients were included: 41 underwent EUS‐GBD and 37 underwent EUS‐CDS. MDBO was mainly the result of pancreatic cancer (n = 63/78, 80.7%). Clinical success rate was similar for both procedures: 87.8% for EUS‐GBD and 89.2% for EUS‐CDS (P = 0.8). Technical success rate was 100% for EUS‐GBD and 94.6% for EUS‐CDS (P = 0.132). Periprocedural morbidity (24 h) among patients in the EUS‐CDS group (8/37 [21.6%]) than in the EUS‐GBD group (3/41 [7.3%]) (P = 0.042). The median follow‐up duration was 4.7 months. Overall survival and time to recurrent biliary obstruction did not significantly differ between the groups.Discussion: After failed ERCP for MDBO, EUS‐GBD and EUS‐CDS show comparable clinical success rates and technical success. EUS‐GBD appears to be a promising alternative for MDBO, even as a second‐line treatment after failed ERCP. Further studies are needed to validate these findings and compare the long‐term outcomes of EUS‐GBD and EUS‐CDS.

Background We aimed to determine risk factors for technical failure of endoscopic ultrasound-guided choledochoduodenostomy (EUS-CDS), evaluate short- and long-term consequences, and identify salvage techniques in patients with biliary obstruction. Methods This retrospective multicenter study of EUS-CDS (2018–2024) included technical failure, classified as type 1 (digestive flange mispositioned), type 2 (biliary flange mispositioned), type 3 (stent deployment failure), type 4 (catheter/lumen-apposing metal stent [LAMS] through the bile duct), and type 5 (others). Controls were successful EUS-CDS in the same center and period. The primary end point was risk factors for failure. Secondary end points were endoscopic rescue techniques and immediate- and long-term consequences. Results Technical failure occurred in 7 % (95 %CI 5–9). Across 23 centers, 296 patients were analyzed (mean age 71 [SD 16] years, 53 % male), including 100 technical failures: type 1 (26 %), type 2 (41 %), type 3 (11 %), type 4 (6 %), type 5 (16 %). Risk factors for technical failure in multivariate analysis included CBD diameter ≤ 15 mm, duodenal stenosis, wired technique, and low operator experience (≤ 10 LAMS). Endoscopic salvage was successful in 77 %, with 53 % using a covered metal stent and 22 % using a new LAMS. Early failures were mild in 56 % of cases, but 12 % resulted in death within 30 days. Immediate endoscopic salvage reduced severe clinical adverse events (P < 0.001) and increased success rates (P < 0.001). Conclusions EUS-CDS failures were not rare and were severe in half of cases. Recognizing risk factors, identifying failures during the procedure, and knowing endoscopic salvage methods are crucial.

J Indian Prosthodont Soc, Official publication of Indian Prosthodontic Society