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Malignant Biliary ObstructionNCT06653192

EUS-guided Choledochoduodenostomy vs ERCP as First Line in Malignant Distal Obstruction (CARPEDIEM Trial)

A study testing Endoscopic biliary drainage, Self-expandable metallic stent (SEMS) and Lumen-apposing metal stent (LAMS) and double-pigtail plastic stent (DPPS) in people with Malignant Biliary Obstruction and Pancreatic Cancer, run by Hospital Universitari de Bellvitge at 10 sites in Spain.

Suspended

Paused. Enrolment is on hold for now and may resume.

Official record
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Trial summary

The aim of this clinical trial is to evaluate the biliary drainage technical failure rate and/or the postprocedure acute pancreatitis rate between EUS-CDS vs ERCP procedures in patients with distal malignant biliary obstruction. Read more about this study

Who is it for?
Ages 18 years and older
What is being tested?
Endoscopic biliary drainage, Self-expandable metallic stent (SEMS) and Lumen-apposing metal stent (LAMS) and double-pigtail plastic stent (DPPS)
Could I receive a placebo?
No, everyone receives an active treatment
How many people
120 participants
Where
10 sitesSpain
Study dates
6 May 2025to 6 May 2028
Phase
Interventional
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Malignant distal biliary obstruction diagnosed in patient considered RESECTABLE or POTENTIALLY RESECTABLE/BORDERLINE with biliary drainage indication: i) impaired hepatic enzymes (including hyperbilirubinemia) x3 times upper the superior normal value. ii) Radiologic singns of extrahepatic bile duct obstruction with presence of retrograde dilatation, of at least 12-mm axial diameter.
  • Consensual malignancy by a bilio-pancreatic multidisciplinar committe (histological confirmation is not mandatory)
  • Patient capable of understanding and/or singning the informed consent.
  • Patient who understands the type of study and will comply with all follow-up tests throughout its duration

Who cannot join

  • Pregnancy or lactation.
  • Severe coagulation disorder: INR > 1.5 non correctable with plasma administration and/or platelet count < 50.000/mm3.
  • Distal malignant biliary strictures in patients considered directly resectable, non-surgical, unresectable, or palliative
  • Benign or uncertain etiology of biliary strictures or strictures located proximally or in close proximity to the hilum.
  • Patients with prior biliary stents or other biliary drainages (e.g., PTCD).
  • Altered intestinal anatomy due to prior surgery that prevents or hinders papillary access (e.g., gastric bypass, Billroth II, duodenal switch, Roux-en-Y).
Show all 11Show fewer
  • Stenosis in the antral or duodenal region that prevents access to the duodenum and reaching the papilla.
  • Situations that do not allow for upper gastrointestinal endoscopy (e.g., esophageal stricture).
  • Patients with functional diversity, who lack the capacity to understand the nature and potential consequences of the study, except when a legal representative is available.
  • Patients incapable of maintaining follow-up appointments (lack of adherence).
  • Lack of informed consent.

Trial locations and contacts

10 sites in 1 country.

10 sites in 1 country

Spain10 sites
  • Hospital General Universitario Dr. Balmis

    Alicante, Alicante, 03010

  • Hospital de Sant Pau i de la Santa Creu

    Barcelona, Catalonia, 08041

  • Hospital General Universitario de Castellón

    Castellon, Castellón, 12004

  • Hospital Universitario Virgen de las Nieves

    Granada, Granada, 18014

  • Hospital Universitari de Bellvitge

    Hospitalet de Llobregat, Barcelona, Catalonia, 08907

  • Complejo Hospitalario de Navarra

    Pamplona, Navarre, 31006

  • Hospital Clínico Universitario de Salamanca

    Salamanca, Salamanca, 37007

  • Hospital Clínico Universitario de Santiago

    Santiago de Compostela, Galicia, 15706

  • Hospital Mútua de Terrassa

    Terrassa, Catalonia, 08221

  • Hospital Clínico Universitario de Valencia

    Valencia, Valencia, 46010

Other trials in Spain

About this study

Official title: Endoscopic Ultrasound-Guided Biliary Drainage With Lumen-Apposing Stent vs Classical ERCP for First-line Therapy of Malignant Distal Biliary Obstruction: An Open-label, Multicenter Randomized Trial (CARPEDIEM Trial)

The aim of this clinical trial is to evaluate the biliary drainage technical failure rate and/or the postprocedure acute pancreatitis rate between EUS-CDS vs ERCP procedures in patients with distal malignant biliary obstruction.

Read the detailed description

Ecoendoscopy-guided choledochoduodenostomy (EUS-CDS) has been extended as a second line treatment in cases of ERCP failure in malignant distal biliary obstruction (MDBO). However, there are clinical trials which have compared it with ERCP as a first line treatment for MDBO in palliative patients, showing similar clinical and technical success and adverse events (AEs) rate between both techniques. Data about the benefit of this techique in potentially surgical patients is still limited.

Recent retrospective study (Janet J et al, Ann Surg Oncol 2023) and two recent meta-analysis (Barbosa E et al, GIE 2024; Gopakumar H et al, AM J Gastr 2024; both with > 500 cases) found that EUS-CDS group had significantly less technical failure rate and less postprocedure pancreatitis rate.

Thus, our hypothesis is that EUS-CDS has benefits in terms of decreasing those rates (technical failure, postprocedure pancreatitis) when compared to ERCP in MDBO in potentially surgical patients with resectable and borderline disease.

Being tested
Endoscopic biliary drainage, Self-expandable metallic stent (SEMS), Lumen-apposing metal stent (LAMS) and double-pigtail plastic stent (DPPS)
Keywords
Choledochoduodenostomy, Therapeutic endoscopy, Biliary Drainage, Lumen apposing metal stent, ERCP, Biliopancreatic malignancy
Medical subject headings
Pancreatic Neoplasms, Biliary Tract Neoplasms

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Endoscopic biliary drainageProcedure or surgery

    Decompression of the bile duct by endoscopic aproach.

  • Self-expandable metallic stent (SEMS)Device

    Self-expandable metallic stent (SEMS) deployment:

    Covering: Uncovered or Partially Covered. Non covered if gallbladder is present.

    Size: 10x40mm or 10x60mm or 10x80mm.

  • Lumen-apposing metal stent (LAMS) and double-pigtail plastic stent (DPPS)Device

    Lumen-apposing metal stent (LAMS) with coaxial double-pigtail plastic stent (DPPS) deployment:

    LAMS size: 6x8mm or 8x8mm. Consider 10x10mm if bile duct > 18mm. DPPS size: 7Fr x 3-7cm.

Study groups in NCT06653192
Study groupRoleWhat they receive
ERCP with SEMSActive comparatorEndoscopic retrograde cholangiopancreatography (ERCP) with deployment of a self-expandable metallic stent (SEMS). Gold standard in malignant distal biliary obstruction (MDBO) in current practice. ERCP technique: Cannulation with papillotome (advanced cannulation techniques are allowed). Sphincterotomy. Self-expandable metallic stent (SEMS) deployment.
Receives: Procedure: Endoscopic biliary drainage; Device: Self-expandable metallic stent (SEMS)
EUS-CDS with LAMS-PigtailExperimentalEchoendoscopy-guided Choledochoduodenostomy (EUS-CDS) with deployment of a lumen-apposing metal stent (LAMS) and axis-orienting double-pigtail plastic stent throug LAMS. EUS-CDS technique: Diagnostic EUS. Classic or free-hand with preloaded guidewire choledochoduodenostomy with LAMS. Pneumatic dilation whithin LAMS is allowed. In case of bile duct < 15mm is mandatory the 'push' technique. Deployment of a pigtail coaxial to LAMS.
Receives: Procedure: Endoscopic biliary drainage; Device: Lumen-apposing metal stent (LAMS) and double-pigtail plastic stent (DPPS)

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Postprocedure surgical challenges rate

    Percentage of biliary drainage technical failure and/or percentage of postprocedure acute pancreatitis.

    Measured: 1 day to 24 months

Secondary outcomes (5)
  1. Clinical success

    In jaundice: decreasing > 50% of bilirrubin or normalization of bilirrubin levels 14 days after endoscopic procedure.

    Measured: 14 days after BD

  2. AE - biliary drainage

    Adverse events rate related to biliary drainage according to the AGREE classification

    Measured: 0 to 30 days after BD

  3. AE - surgery

    Adverse events rate related to surgery according to the Claiven and Dindo classification.

    Measured: 0 to 90 days after surgery

  4. Delay in days between endoscopic biliary drainage and cephalic duodenopancreatectomy (CDP)

    Number of days between intervention (T1-biliary drainage) and surgery

    Measured: 1 day to 6 months

  5. Rate of surgery

    Rate of patients that undergo to surgery

    Measured: 1 to 24 months

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted22 Oct 2024
  2. Study start6 May 2025
  3. Primary completion6 Jun 2027 (estimated)
  4. Study completion6 May 2028 (estimated)

Why it stopped: Class I Recall (Feb 2026): Boston Scientific issued a global recall for specific lots of AXIOS 6x8mm and 8x8mm due to reports of deployment and expansion failure during the procedure.

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
Single blind
Who is masked
Outcomes assessor
Enrolment
120 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT06653192
Sponsor's protocol ID
CARPEDIEM
Status last verified
May 2025
First submitted
19 Oct 2024
Last updated
6 May 2026
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
Yes
Individual data sharing
Undecided

Publications

  • Teoh AYB, Napoleon B, Kunda R, Arcidiacono PG, Kongkam P, Larghi A, Van der Merwe S, Jacques J, Legros R, Thawee RE, Saxena P, Aerts M, Archibugi L, Chan SM, Fumex F, Kaffes AJ, Ma MTW, Messaoudi N, Rizzatti G, Ng KKC, Ng EKW, Chiu PWY. EUS-Guided Choledocho-duodenostomy Using Lumen Apposing Stent Versus ERCP With Covered Metallic Stents in Patients With Unresectable Malignant Distal Biliary Obstruction: A Multicenter Randomized Controlled Trial (DRA-MBO Trial). Gastroenterology. 2023 Aug;165(2):473-482.e2. doi: 10.1053/j.gastro.2023.04.016. Epub 2023 Apr 28.

    PubMed 37121331
  • Janet J, Albouys J, Napoleon B, Jacques J, Mathonnet M, Magne J, Fontaine M, de Ponthaud C, Durand Fontanier S, Bardet SSM, Bourdariat R, Sulpice L, Lesurtel M, Legros R, Truant S, Robin F, Prat F, Palazzo M, Schwarz L, Buc E, Sauvanet A, Gaujoux S, Taibi A. Pancreatoduodenectomy Following Preoperative Biliary Drainage Using Endoscopic Ultrasound-Guided Choledochoduodenostomy Versus a Transpapillary Stent: A Multicenter Comparative Cohort Study of the ACHBT-FRENCH-SFED Intergroup. Ann Surg Oncol. 2023 Aug;30(8):5036-5046. doi: 10.1245/s10434-023-13466-8. Epub 2023 Apr 17.

    PubMed 37069476
  • Chen YI, Sahai A, Donatelli G, Lam E, Forbes N, Mosko J, Paquin SC, Donnellan F, Chatterjee A, Telford J, Miller C, Desilets E, Sandha G, Kenshil S, Mohamed R, May G, Gan I, Barkun J, Calo N, Nawawi A, Friedman G, Cohen A, Maniere T, Chaudhury P, Metrakos P, Zogopoulos G, Bessissow A, Khalil JA, Baffis V, Waschke K, Parent J, Soulellis C, Khashab M, Kunda R, Geraci O, Martel M, Schwartzman K, Fiore JF Jr, Rahme E, Barkun A. Endoscopic Ultrasound-Guided Biliary Drainage of First Intent With a Lumen-Apposing Metal Stent vs Endoscopic Retrograde Cholangiopancreatography in Malignant Distal Biliary Obstruction: A Multicenter Randomized Controlled Study (ELEMENT Trial). Gastroenterology. 2023 Nov;165(5):1249-1261.e5. doi: 10.1053/j.gastro.2023.07.024. Epub 2023 Aug 6.

    PubMed 37549753
  • Barbosa EC, Santo PADE, Baraldo S, Nau AL, Meine GC. EUS- versus ERCP-guided biliary drainage for malignant biliary obstruction: a systematic review and meta-analysis of randomized controlled trials. Gastrointest Endosc. 2024 Sep;100(3):395-405.e8. doi: 10.1016/j.gie.2024.04.019. Epub 2024 Apr 20.

    PubMed 38648989
  • Gopakumar H, Singh RR, Revanur V, Kandula R, Puli SR. Endoscopic Ultrasound-Guided vs Endoscopic Retrograde Cholangiopancreatography-Guided Biliary Drainage as Primary Approach to Malignant Distal Biliary Obstruction: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Am J Gastroenterol. 2024 Aug 1;119(8):1607-1615. doi: 10.14309/ajg.0000000000002736. Epub 2024 Feb 29.

    PubMed 38421018

Questions about this trial

What is this clinical trial studying?

A study testing Endoscopic biliary drainage, Self-expandable metallic stent (SEMS) and Lumen-apposing metal stent (LAMS) and double-pigtail plastic stent (DPPS) in people with Malignant Biliary Obstruction and Pancreatic Cancer, run by Hospital Universitari de Bellvitge at 10 sites in Spain.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 4 inclusion and 11 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: paused, as of the sponsor's last update on 6 May 2026. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 10 sites in Spain. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

Results are not available in the source record.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Postprocedure surgical challenges rate (time frame: 1 day to 24 months). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT06653192, which also lists 5 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 6 May 2026.

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Clinical Trial NCT06653192 | AzTrials