Endoscopic ultrasound-guided choledochoduodenostomy for malignant distal biliary obstruction after failed endoscopic retrograde cholangiopancreatography with partially covered self-expanding metal stent

Abstract

Background and Objectives:Endoscopic ultrasound-guided choledochoduodenostomy (EUS-CD) is an alternative procedure to percutaneous transhepatic biliary drainage for patients with malignant distal biliary obstruction requiring biliary drainage in whom ERCP has failed. We studied technical success, clinical success, stent patency rate, and adverse events in EUS-CD.Methods:It is a prospective study from January 2015 to December 2016. Patients with unresectable, malignant distal biliary obstruction requiring biliary drainage in whom ERCP had failed either because of failed cannulation of papilla or due to duodenal stenosis were included. EUS-CD was done using a 6 cm partially covered self-expanding metal stent. Technical success, clinical success (more than 50% reduction in total bilirubin by week 2), stent patency rate, and adverse events were assessed. Patients were followed up for 3 months.Results:Thirty patients underwent EUS-CD, 20 (66.7%) had failed cannulation of papilla, and 10 (33.3%) had duodenal stenosis. EUS-CD was successfully done in 28 patients; all of those had clinical success. Total bilirubin (in median) decreased from 20 mg/dl to 5 mg/dl by week 2. Four patients (13.3%) had adverse events; two had bile leak, one had hemobilia, and other had stent block due to sludge. None had major adverse events; all adverse events were managed successfully. Five died due to progression of disease within 3 months (range: 40–88 days) with 3-month stent dysfunction-free patency rate of 83.33%. No procedure-related mortality occurred.Conclusion:EUS-CD with a partially covered metal stent has a high technical and clinical success with no major adverse events.