Feasibility and safety of EUS-guided choledochoduodenostomy

Abstract

Objective To analyze the feasibility and safety of EUS-guided choledochoduodenostomy(EUS-CDS) when routine ERCP failed. Methods Data of 3 consecutive patients with malignant lower bile duct obstruction, who underwent EUS-CDS with dual mushroom type covered metal stents (DMCMSs) between April 2016 and June 2016 after unsuccessful ERCP in a single center were retrospectively analysed. The treatment outcome and short-term complications were evaluated. Results EUS-CDSs were successfully performed in all 3 study patients (M/F 1/2, mean age 67.3, range 56-82) and DMCMSs were placed with a mean procedural time of 20.7 min (18-25 min). ERCP failure was due to lower common bile duct malignancy in 1 patient, and pancreatic cancer in 2 others. One patient developed duodenal bleeding after the procedure, which was successfully managed by radiological intervention. Significant reduction of serum bilirubin and liver enzyme level occurred in all 3 patients and they were all discharged. Conclusion EUS-CDS is a safe and feasible rescue method after unsuccessful ERCP at an experienced endoscopic center. Key words: Intestinal fistula; Duodenostomy; Endosonography; Stents; Feasibility studies