Abstract
Endoscopic transpapillary biliary drainage is the criterion standard procedure for biliary decompression. However, ERCP can fail in 3% to 10% of cases. 1 Ang T.L. Teo E.K. Fock K.M. EUS-guided transduodenal biliary drainage in unresectable pancreatic cancer with obstructive jaundice. JOP. 2007; 8: 438-443 PubMed Google Scholar , 2 Artifon E.L. Chaves D.M. Ishioka S. et al. Echoguided hepatico-gastrostomy: a case report. Clinics (Sao Paulo). 2007; 62: 799-802 Crossref PubMed Scopus (45) Google Scholar , 3 Burmester E. Niehaus J. Leineweber T. et al. EUS-cholangio-drainage of the bile duct: report of 4 cases. Gastrointest Endosc. 2003; 57: 246-251 Abstract Full Text PDF PubMed Scopus (277) Google Scholar , 4 Kahaleh M. Hernandez A.J. Tokar J. et al. Interventional EUS-guided cholangiography: evaluation of a technique in evolution. Gastrointest Endosc. 2006; 64: 52-59 Abstract Full Text Full Text PDF PubMed Scopus (253) Google Scholar In these cases, percutaneous transhepatic biliary drainage and surgical intervention are the alternatives. 1 Ang T.L. Teo E.K. Fock K.M. EUS-guided transduodenal biliary drainage in unresectable pancreatic cancer with obstructive jaundice. JOP. 2007; 8: 438-443 PubMed Google Scholar , 3 Burmester E. Niehaus J. Leineweber T. et al. EUS-cholangio-drainage of the bile duct: report of 4 cases. Gastrointest Endosc. 2003; 57: 246-251 Abstract Full Text PDF PubMed Scopus (277) Google Scholar , 4 Kahaleh M. Hernandez A.J. Tokar J. et al. Interventional EUS-guided cholangiography: evaluation of a technique in evolution. Gastrointest Endosc. 2006; 64: 52-59 Abstract Full Text Full Text PDF PubMed Scopus (253) Google Scholar These alternatives have significant morbidity. 5 Covey A.M. Brown K.T. Percutaneous transhepatic biliary drainage. Tech Vasc Interv Radiol. 2008; 11: 14-20 Abstract Full Text Full Text PDF PubMed Scopus (48) Google Scholar , 6 Smith A.C. Dowsett J.F. Russell R.C. et al. Randomised trial of endoscopic stenting versus surgical bypass in malignant low bile duct obstruction. Lancet. 1994; 344: 1655-1660 Abstract PubMed Scopus (797) Google Scholar , 7 Lai E.C. Mok F.P. Tan E.S. et al. Endoscopic biliary drainage for severe acute cholangitis. N Engl J Med. 1992; 24: 1582-1586 Crossref Scopus (474) Google Scholar , 8 Pessa M.E. Hawkins I.F. Vogel S.B. The treatment of acute cholangitis: percutaneous transhepatic biliary drainage before definitive therapy. Ann Surg. 1987; 72: 389-392 Crossref Scopus (74) Google Scholar However, a more recent option is EUS-guided biliary drainage (EUS-BD). We describe a case of unresectable pancreatic cancer with biliary obstruction and extensive duodenal invasion that was successfully treated with a variation of the EUS-BD by performing a choledochoantrostomy.
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