Commentary

Endoscopic ultrasound-guided choledochoduodenostomy (EUS-CDS) is a valuable tool to palliate malignant distal biliary stricture. With the availability of electrocautery-enhanced lumen-apposing metal stents (“Hot” LAMSs) this procedure, in expert hands and given a common bile duct (CBD) diameter greater than 12mm, is easy, quick, and safe, with a very low rate of adverse events, and these can usually be solved endoscopically.

So the use of an “old-fashioned” technique, such as the one performed in this video, is left to cases where the CBD diameter is less than 12mm or as salvage treatment in cases of misdeployment (mainly type 1). In this setting, when a hole has been created by the Hot LAMS cautery device, the use of the inflated balloon like “the boy who kept his finger in the dike” to compress the wall, theoretically reducing the bile outflow, could have a role but further data are needed.

Publikationsverlauf

Artikel online veröffentlicht:
24. September 2025