Outcomes Using Secondary Percutaneous Access during Duodenal Stenting

Introduction: Duodenal stenting (DS) is normally performed endoscopically. Cases may be referred to IR following endoscopic failure or if there is coexisting biliary obstruction. Antegrade approach (AA) in IR may also fail. This study was to assess the outcomes using percutaneous secondary retrograde access (RA).

Method(s): Retrospective review of all referrals for DS in IR between 2013 to 2022. All patients had transgastric AA. If the duodenal stricture could not be crossed during AA, some cases had RA with duodenal puncture using a 21 g needle under fluoroscopic guidance. RA was limited to 6F and used to facilitate crossing the stricture to allow completion of DS. Forty-two patients were referred for DS, all had AA and 12 had additional RA after failure from AA alone. Mean age 60 years (range 25–79), M:F ratio 20:22.

Result(s): Technical success: overall 37/42 (88%), with AA alone 25/42 (59.5%), with additional RA 10/12 (83%). In the AA group 2 further patients had successful completion using the biliary access for RA. Complications in the RA group were, self-limiting pain in 8 patients, no other complications were seen.

Conclusion(s): Secondary percutaneous retrograde duodenal access is useful during duodenal stenting. The complication rate from secondary access appears to be low if the secondary access is limited to 6F.

Publication History

Article published online:
09 February 2023