BACKGROUND: Endoscopic ultrasonography (EUS)-guided choledochoduodenostomy (CDS) is as an alternative to percutaneous transhepatic biliary drainage (PTBD) in patients with biliary obstruction when endoscopic retrograde biliary drainage (ERBD) is unsuccessful. PURPOSE: We reviewed our experience and technique in patients undergoing EUS-CDS. PATIENTS: Over a 2-year period to December 2008, 15 patients with unsuccessful ERBD underwent EUS-CDS. METHODS: EUS-guided needle puncture was performed to access the bile duct from the duodenal bulb. After cholangiography, a guidewire was inserted through the needle and directed to the hepatic hilum. The punctured fistula was then dilated with a biliary dilator and a plastic stent was inserted. RESULTS: The technical success rate of EUS-CDS was 93% (14/15 patients); 1 patient underwent an EUS-guided rendezvous approach because the choledochoduodenal fistula could not be dilated. Decompression of the bile duct was achieved in all patients. Complications included cholangitis in 4 patients, self-limiting local peritonitis in 2 and distal stent migration in 1 patient. The median follow-up time was 125 days and the median duration of stent patency was 99 days. CONCLUSION: EUS-CDS may be effective for patients following unsuccessful ERBD and offers an attractive alternative to PTBD.
BACKGROUND: Endoscopic ultrasonography (EUS)-guided choledochoduodenostomy (CDS) is as an alternative to percutaneous transhepatic biliary drainage (PTBD) in patients with biliary obstruction when endoscopic retrograde biliary drainage (ERBD) is unsuccessful. PURPOSE: We reviewed our experience and technique in patients undergoing EUS-CDS. PATIENTS: Over a 2-year period to December 2008, 15 patients with unsuccessful ERBD underwent EUS-CDS. METHODS: EUS-guided needle puncture was performed to access the bile duct from the duodenal bulb. After cholangiography, a guidewire was inserted through the needle and directed to the hepatic hilum. The punctured fistula was then dilated with a biliary dilator and a plastic stent was inserted. RESULTS: The technical success rate of EUS-CDS was 93% (14/15 patients); 1 patient underwent an EUS-guided rendezvous approach because the choledochoduodenal fistula could not be dilated. Decompression of the bile duct was achieved in all patients. Complications included cholangitis in 4 patients, self-limiting local peritonitis in 2 and distal stent migration in 1 patient. The median follow-up time was 125 days and the median duration of stent patency was 99 days. CONCLUSION:EUS-CDS may be effective for patients following unsuccessful ERBD and offers an attractive alternative to PTBD.
Authors: Leticia Perondi Luz; Mohammad Ali Al-Haddad; Michael Sai Lai Sey; John M DeWitt Journal: World J Gastroenterol Date: 2014-06-28 Impact factor: 5.742
Authors: Carlo Fabbri; Carmelo Luigiano; Andrea Lisotti; Vincenzo Cennamo; Clara Virgilio; Giancarlo Caletti; Pietro Fusaroli Journal: World J Gastroenterol Date: 2014-07-14 Impact factor: 5.742