Combined endoscopic mAnagement of BiliaRy and gastrIc OutLET obstruction (CABRIOLET Study): A multicenter retrospective analysis.

Combined biliary obstruction and gastric outlet obstruction (GOO) represent a challenging clinical scenario despite developments in therapeutic endoscopic ultrasonography (EUS) as GOO might impair EUS-guided biliary drainage. Little is known about the effectiveness of different therapeutic combinations used to treat double obstruction, especially regarding stent patency. All consecutive patients with double obstruction treated between 2016 and 2021 in three tertiary academic centres were eligible for inclusion. Five combinations involving enteral stenting (ES), EUS-guided gastroenterostomy (EUS-GE), hepaticogastrostomy (EUS-HGS), choledochoduodenostomy (EUS-CDS), and transpapillary biliary stenting (TPS) were evaluated for dysfunction during follow-up, either as proportions or dysfunction-free survival (DFS) using Kaplan-Meier estimates. Ninety-three patients were included (male 46%; age 67 [interquartile range 60-76] years; pancreatic cancer 73%, metastatic 57%), resulting in 103 procedure combinations. Different combinations showed significantly different overall dysfunction rates ( Despite a lack of statistical power per combination, this study introduces new associations beyond the increased risk of GOO recurrence with ES versus EUS-GE. EUS-CDS showed reduced effectiveness and frequent dysfunction in the context of GOO, especially when combined with ES. EUS-GE+HGS or EUS-GE+TPS in this setting might result in superior patency. These results suggest that a prospective evaluation of the optimal endoscopic approach to malignant double obstruction is needed.

Informations de copyright

© 2022 The Authors. DEN Open published by John Wiley & Sons Australia, Ltd on behalf of Japan Gastroenterological Endoscopy Society.

Déclaration de conflit d'intérêts

Michiel Bronswijk has consultancy agreements with Taewoong/ Prion Medical, and reports travel grants from Taewoong, Norgine, and Prion Medical; Roy LJ van Wanrooij holds a consultancy agreement with Boston‐Scientific. Wim Laleman co‐chairs the Boston‐Scientific Chair in Therapeutic Biliopancreatic Endoscopy, and has consultancy agreements with Boston Scientific and Cook Medical. Hannah van Malenstein holds a consultancy agreement with Boston‐Scientific. Paul Fockens holds a consultancy agreement with Olympus and Cook Medical. Schalk van der Merwe co‐chairs the Boston‐Scientific Chair in Therapeutic Biliopancreatic Endoscopy, holds the Cook Medical chair in Portal Hypertension, and holds consultancy agreements with Boston Scientific, Cook Medical and Pentax. Rogier P Voermans reports a consultancy agreement and research grant from Boston‐Scientific. All other authors declare no conflict of interest.