EUS-guided choledochoduodenostomy for palliative biliary drainage: report of 5 cases

Objective: Endoscopic biliary drainage may be unsuccessful in some patients because of failed biliary cannulation, or tumor infiltration limiting papillary access. The alternative method of percutaneous transhepatic biliary drainage (PTBD) has a risk of complications such as bleeding and intra- or extra abdominal bile leakage. Recently, endoscopic ultrasound (EUS) guided biliary stent placement has been described in patients with malignant biliary obstruction. We describe our 5 cases-experience of EUS guided biliary drainage from first portion of the duodenum. Methods: Five cases of choledochoduodenostomy via first portion of the duodenum using convex echoendoscope (GF-UCT240, Olympus, Tokyo, Japan) and needle knife (Zimmon papillotomy knife, Willson-Cook, NC, USA) were performed. We successfuly exchanged the accessories, such as needles, guide wires (Jag wire 0.035inch, 450cm, Boston Scientific, Boston, USA), biliary dilators (Soehendra biliary dilator catheters, SBDC-7 and SBDC-9, Willson-Cook, NC, USA), and stents, several times through the convex echoendoscope. Results: Stent insertion was technically successful in all 5 patients. The procedure was also clinically effective in relieveing jaundice in all cases. One patient developed pnuemoperitoneum one day after procedure, which resolved conservatively with fasting and antibiotics in few days. Early stent occlusion occurred in one patient after 5 weeks, which made a repeat procedure with exchange stent easily. Average patency of stents reaches more than 170 days (31–274 days). Conclusion: EUS-guided choledochoduodenostomy from first portion of the duodenum is a feasible and safe, and become alternative to PTBD for drainage of obstructed biliary system, in the future.