EUS-guided choledochoduodenostomy (EUS-CDS) for patients with malignant biliary obstruction

Introduction:

Recent years have seen remarkable advances in interventional EUS. One of recent advances is endoscopic ultrasoundguided

biliary drainage. Since 2003, we have performed EUS-CDS for 42 pts (patients) with unresectable malignant lower biliary obstruction. The safety and efficacy of the EUS-CDS procedure were investigated.

Aims & Methods:

EUS-CDS was performed in accordance with the method described by author. (HARA K, et al. Digestive Endoscopy 2010). A stent was put in place between the extrahepatic bile duct and the duodenal bulb under EUS guidance.

Results:

• The success rate of the procedure was 98% (41/42 pts).

• In the first procedure, Covered Metallic Stent was inserted in 8pts and plastic stent was in 33pts.

• Serious adverse events is 1 hemorrhage. Mild abdominal pain occurred in 4pts.

• The median duration of the EUS-CDS procedure was approximately 30min.

• Favorable improvement in the hepatic disorder was seen in 98% (41/42 pts).

• The median time of oral intake is one day after EUS-CDS.

• Both a duodenal stent and EUS-CDS were employed in 3 patients, but there was no interference between the stents and the clinical course of the patients was good.

Conclusion:

The success rate with EUS-CDS was high, and the procedure could be performed relatively safely. However, it is surmised that further technical improvements are needed, such as development of special devices. In the event of such improvements, the technique may replace endoscopic biliary drainage for malignant biliary obstruction.