{
  "abstract": "Introduction The electrocautery-enhanced Hot Axios™ stent (Boston Scientific) is licensed for EUS choledochoduodenostomy (EUS CDD) and is recognised as an effective modality in biliary drainage in distal malignant biliary obstruction (DMBO). The 6mm x 8mm (6mm) and 8mm x 8mm (8mm) diameter stents are most commonly used for this purpose. In December 2025, an urgent recall of the 6mm and 8mm Hot Axios™ stents was issued due to reports of stent deployment and expansion issues, creating an urgent need for an evidence-based effective alternative.This study presents the first direct comparison of the 10mm x 10mm (10mm) Hot Axios™ stents with the 6mm and 8mm (6/8mm) Hot Axios™ stents in EUS CDD for DMBO.Methods A retrospective review was conducted of EUS CDD for DMBO performed in 3 UK tertiary pancreas units from May 2024 to December 2025 using Hot Axios™ stents. One centre exclusively used 10mm Hot Axios™ stents for EUS CDD, while the other centres used 6mm and 8mm stents. Technical success, clinical success and adverse event rates were analysed. Technical success was defined as successful Hot Axios™ stent deployment for EUS CDD. Clinical success was defined as a 50% drop in bilirubin in 2 weeks post EUS CDD.Results 76 patients underwent EUS CDD for DMBO (10 mm group n=28; 6/8 mm group n=46). Procedural technique differed significantly between groups; most procedures in the 10 mm group were performed freehand with a guidewire preloaded (27/28), whilst in the 6/8mm group, 38/46 were performed freehand. Coaxial plastic stents were inserted through 24/25 successfully deployed 10 mm stents, versus 6/41 in the 6/8 mm group (p<0.05).When comparing the 10mm and 6/8mm groups, there was no statistically significant difference in median target duct size on EUS (18.0mm vs 17.5mm, p=0.06).Technical success (89.3% (25/28) vs 89.1% (41/46), p=1.00), post-procedural adverse events (10.7% (3/28) vs 10.9% (5/46), p=1.00) and 30-day mortality (10.7% (3/28) vs 8.7% (4/46), p = 1.00) were comparable between the 2 groups.After exclusion of technically unsuccessful cases, biliary re-intervention rates were similar (4.0% (1/25) vs 2.4% (1/41), p=1.00). Following further exclusion of cases without follow-up biochemistry, clinical success did not differ significantly between groups (91.3% (21/23) vs 97.1% (34/35), p=0.56).Conclusions The 10mm × 10mm Hot Axios™ stent demonstrates comparable efficacy and safety to 6mm x 8mm and 8mm x 8mm stents for EUS CDD in DMBO and represents a viable alternative following the recall of smaller diameter devices.",
  "authors": [
    {
      "affiliations": [
        "Royal Liverpool University Hospital, Liverpool, United Kingdom"
      ],
      "name": "Khoon Sheng Kok"
    },
    {
      "affiliations": [
        "Royal Liverpool University Hospital, Liverpool, United Kingdom"
      ],
      "name": "Jonathan Evans"
    },
    {
      "affiliations": [
        "Royal Liverpool University Hospital, Liverpool, United Kingdom"
      ],
      "name": "Edward Britton"
    },
    {
      "affiliations": [
        "University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom"
      ],
      "name": "Nadeem Tehami"
    },
    {
      "affiliations": [
        "University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom"
      ],
      "name": "Ben Maher"
    },
    {
      "affiliations": [
        "University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom"
      ],
      "name": "Danylo Yershov"
    },
    {
      "affiliations": [
        "Freeman Hospital, Newcastle, United Kingdom"
      ],
      "name": "Manu Nayar"
    },
    {
      "affiliations": [
        "Freeman Hospital, Newcastle, United Kingdom"
      ],
      "name": "Khalid Bashir"
    },
    {
      "affiliations": [
        "Freeman Hospital, Newcastle, United Kingdom"
      ],
      "name": "John Leeds"
    }
  ],
  "title": "P42 10mm×10mm hot axios™ stents are safe and effective for EUS-guided choledochoduodenostomy: a comparative multicentre study",
  "uid": "c50e68cf-5f50-5f50-95e2-a4cb70f2c309"
}