{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T10:31:44Z","timestamp":1788517904430,"version":"build-2803163510"},"reference-count":20,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2023,12,5]],"date-time":"2023-12-05T00:00:00Z","timestamp":1701734400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Digestive Endoscopy"],"published-print":{"date-parts":[[2024,4]]},"abstract":"<jats:p>Endoscopic ultrasound\u2010guided choledochoduodenostomy (EUS\u2010CDS) with lumen apposing metal stent is emerging both as a rescue strategy and a primary treatment for distal malignant biliary obstruction. The large\u2010scale diffusion of the procedure and improved overall survival of patients with pancreatobiliary neoplasms is resulting in a growing population of long\u2010term EUS\u2010CDS lumen apposing metal stent carriers. Recent studies have reported a need for reintervention during follow\u2010up as high as 55%, and the Leuven\u2010Amsterdam\u2010Milan Study Group classification has been developed, identifying five mechanisms of stent dysfunction and 11 possible rescue strategies aimed at restoring biliary drainage. This illustrated technical review aims to further dissect the recent classification through a comprehensive analysis of nine illustrative cases, offering insights into the pathophysiology underlying dysfunction and clinical reasoning behind rescue interventions, as well as technical considerations and practical tips and tricks. By exploring mechanisms of dysfunction, this review also assists clinicians in selecting the ideal candidates for EUS\u2010CDS while identifying patients deemed high risk for dysfunction or clinical failure.<\/jats:p>","DOI":"10.1111\/den.14708","type":"journal-article","created":{"date-parts":[[2023,10,19]],"date-time":"2023-10-19T01:40:46Z","timestamp":1697679646000},"page":"481-491","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Managing dysfunctions and reinterventions in endoscopic ultrasound\u2010guided choledochoduodenostomy with lumen apposing metal stents: Illustrated technical review (with videos)"],"prefix":"10.1111","volume":"36","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7280-1761","authenticated-orcid":false,"given":"Giuseppe","family":"Vanella","sequence":"first","affiliation":[{"name":"Pancreatobiliary Endoscopy and Endosonography Division IRCCS San Raffaele Scientific Institute  Milan Italy"},{"name":"Vita\u2010Salute San Raffaele University  Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giuseppe","family":"Dell'Anna","sequence":"additional","affiliation":[{"name":"Pancreatobiliary Endoscopy and Endosonography Division IRCCS San Raffaele Scientific Institute  Milan Italy"},{"name":"Vita\u2010Salute San Raffaele University  Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roy L. 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