Evidence map›Paper›PMID 41511419›Full record

Trial reportGastroenterology2026

Endoscopic Ultrasound-Guided Choledochoduodenostomy vs Endoscopic Retrograde Cholangiopancreatography in Malignant Distal Biliary Obstruction to Prevent Postprocedural Pancreatitis: A Randomized Trial.

Andrea Anderloni, Marco Spadaccini, Cecilia Binda, Aurelio Mauro, Serena Stigliano, Lucio Carrozza, Matteo Colombo, Stefano Mazza, Chiara Coluccio, Arnaldo Amato and 12 more

Registry-linked trialAbstract readMulticenter StudyRandomized Controlled TrialComparative Study
PubMed Publisher
In one paragraph

Trial report in Gastroenterology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT04099862 (Eus-giuded Biliary Drainage With Ec-lams vs ERCP as a Primary Intervention for Endoscopic Treatment of Patinets With Distal Malignant Biliary Obstruction), which is not on this map. Cited by 7 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
7citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT04099862 completednot on this map

Eus-giuded Biliary Drainage With Ec-lams vs ERCP as a Primary Intervention for Endoscopic Treatment of Patinets With Distal Malignant Biliary Obstruction

TypeobservationalSponsorIstituto Clinico HumanitasRan2021 to 2024Enrolled220ConditionsDISTAL MALIGNANT BILIARY OBSTRUCTIONArmsERCP, EUS-BD
3 · Its place in the literature

Who cites it

7 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
  2. Review
  3. Review
  4. Review
  5. Review
  6. Article
  7. Article
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

22 authors.

Andrea AnderloniFondazione IRCCS Policlinico San Matteo, Gastroenterology and Digestive Endoscopy Unit, Pavia, Italy.
Marco SpadacciniHumanitas University, Department of Biomedical Sciences, Pieve Emanuele, Italy; Humanitas Clinical and Research Center-IRCCS, Endoscopy Unit, Rozzano, Italy. Electronic address: marco.spadaccini@humanitas.it.
Cecilia BindaForlì-Cesena Hospitals, Gastroenterology and Digestive Endoscopy Unit, AUSL Romagna, Forlì-Cesena, Italy.
Aurelio MauroFondazione IRCCS Policlinico San Matteo, Gastroenterology and Digestive Endoscopy Unit, Pavia, Italy.
Serena StiglianoCampus Bio-Medico, University of Rome, Digestive Endoscopy Unit, Rome, Italy.
Lucio CarrozzaIRCCS-ISMETT, Endoscopy Service, Department of Diagnostic and Therapeutic Services, Palermo, Italy.
Matteo ColomboHumanitas Clinical and Research Center-IRCCS, Endoscopy Unit, Rozzano, Italy.
Stefano MazzaFondazione IRCCS Policlinico San Matteo, Gastroenterology and Digestive Endoscopy Unit, Pavia, Italy.
Chiara ColuccioForlì-Cesena Hospitals, Gastroenterology and Digestive Endoscopy Unit, AUSL Romagna, Forlì-Cesena, Italy.
Arnaldo AmatoValduce Hospital, Gastroenterology Unit, Como, Italy.
Marta AndreozziHumanitas Clinical and Research Center-IRCCS, Endoscopy Unit, Rozzano, Italy.
Giacomo Emanuele Maria RizzoIRCCS-ISMETT, Endoscopy Service, Department of Diagnostic and Therapeutic Services, Palermo, Italy.
Antonio FacciorussoUniversity of Foggia, Department of Medical Sciences, Section of Gastroenterology, Foggia, Italy.
Franco RadaelliValduce Hospital, Gastroenterology Unit, Como, Italy.
Silvia CarraraHumanitas University, Department of Biomedical Sciences, Pieve Emanuele, Italy; Humanitas Clinical and Research Center-IRCCS, Endoscopy Unit, Rozzano, Italy.
Benedetto MangiavillanoHumanitas University, Department of Biomedical Sciences, Pieve Emanuele, Italy; Istituto Clinico Mater Domini Casa di Cura Privata SpA, Gastrointestinal Endoscopy, Castellanza, Italy.
Francesco Maria Di MatteoCampus Bio-Medico, University of Rome, Digestive Endoscopy Unit, Rome, Italy.
Ilaria TarantinoIRCCS-ISMETT, Endoscopy Service, Department of Diagnostic and Therapeutic Services, Palermo, Italy.
Cesare HassanHumanitas University, Department of Biomedical Sciences, Pieve Emanuele, Italy; Humanitas Clinical and Research Center-IRCCS, Endoscopy Unit, Rozzano, Italy.
Alessandro RepiciHumanitas University, Department of Biomedical Sciences, Pieve Emanuele, Italy; Humanitas Clinical and Research Center-IRCCS, Endoscopy Unit, Rozzano, Italy.
Alessandro FugazzaHumanitas Clinical and Research Center-IRCCS, Endoscopy Unit, Rozzano, Italy.
Carlo FabbriForlì-Cesena Hospitals, Gastroenterology and Digestive Endoscopy Unit, AUSL Romagna, Forlì-Cesena, Italy.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

BACKGROUND &

aimsPostprocedural pancreatitis is the most common adverse event (AE) associated with endoscopic retrograde cholangiopancreatography (ERCP). Endoscopic ultrasound-guided choledochoduodenostomy (EUS-CDS) using a lumen-apposing metal stent is emerging as a promising approach for managing malignant distal biliary obstruction, offering the potential to lower the risk of postprocedural pancreatitis.

methodsThis was a multicenter randomized study, enrolling consecutive patients admitted for obstructive jaundice due to malignant distal biliary obstruction with dilated common bile duct (≥15 mm). Patients were randomly allocated to receive EUS-CDS or ERCP for primary biliary drainage. This was a superiority trial with postprocedural acute pancreatitis as primary outcome. Other outcomes included technical success, clinical success, AEs, 6-month stent patency rate, and overall survival. Analyses were performed according to intention-to-treat principles.

resultsBetween April 2021 and October 2023, 220 patients were enrolled in the study (EUS-CDS, 111; ERCP, 109). EUS-CDS group showed a lower risk for postprocedural acute pancreatitis (1.8% in EUS-CDS vs 7.3% in ERCP; relative risk, 0.25; 95% confidence interval, 0.07-0.88). Technical success was achieved in 94.6% in EUS-CDS group vs 78.9% ERCP group (P < .001), in a mean procedural time of 13.5 ± 11.6 minutes and 24.7 ± 14.9 minutes, respectively (P <.001). No differences were found in other AEs (19.8% in EUS-CDS vs 21.1% in ERCP; relative risk, 0.94; 95% confidence interval, 0.56-1.58), clinical success, stent patency, or overall mortality.

conclusionsEUS-CDS is superior to ERCP in reducing postprocedural acute pancreatitis risk. However, the overall risk of AEs was not significantly different and warrants further investigation. Additionally EUS-CDS showed improved technical success and comparable clinical efficacy. These results support a potential role of EUS-CDS as primary approach in selected patients with dilated common bile duct (ClinicalTrials.gov, Number: NCT04099862).

Indexed as

Cholangiopancreatography, Endoscopic RetrogradeCholedochostomyCholestasisEndosonographyJaundice, ObstructivePancreatitisUltrasonography, InterventionalAgedDrainageFemaleHumansMaleMiddle AgedStentsTreatment OutcomeCancerInterventional EUSJaundicePancreas

Identifiers

PMID41511419

What OpenQuestion holds

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.