Case Report
Copyright ©2008 The WJG Press and Baishideng. All rights reserved.
World J Gastroenterol. Oct 21, 2008; 14(39): 6078-6082
Published online Oct 21, 2008. doi: 10.3748/wjg.14.6078
Endoscopic ultrasound-guided choledochoduodenostomy in patients with failed endoscopic retrograde cholangiopancreatography
Takao Itoi, Fumihide Itokawa, Atsushi Sofuni, Toshio Kurihara, Takayoshi Tsuchiya, Kentaro Ishii, Shujiro Tsuji, Nobuhito Ikeuchi, Fuminori Moriyasu
Takao Itoi, Fumihide Itokawa, Atsushi Sofuni, Toshio Kurihara, Takayoshi Tsuchiya, Kentaro Ishii, Shujiro Tsuji, Nobuhito Ikeuchi, Fuminori Moriyasu, Department of Gastroenterology and Hepatology, Tokyo Medical University Hospital, Tokyo 160-0023, Japan
Author contributions: Itoi T, Itokawa F, and Sofuni A were responsible for study design, data analysis, and script preparation; Itoi T and Itokawa F performed endoscopic diagnosis and treatment; Kurihara T, Tsuchiya T, Ishii K, Tsuji S and Ikeuchi N were responsible for the data collection; Moriyasu F reviewed this manuscript; and all authors have read and approved submitted version of the manuscript.
Correspondence to: Takao Itoi, MD, Department of Gastroenterology and Hepatology, Tokyo Medical University Shinjuku-ku, Nishishinjuku 6-7-1, Tokyo 160-0023, Japan. itoi@tokyo-med.ac.jp
Telephone: +81-3-33426111 Fax: +81-3-53816654
Received: June 26, 2008
Revised: September 16, 2008
Accepted: September 23, 2008
Published online: October 21, 2008
Abstract

Endoscopic ultrasonography (EUS)-guided biliary drainage was performed for treatment of patients who have obstructive jaundice in cases of failed endoscopic retrograde cholangiopancreatography (ERCP). In the present study, we introduced the feasibility and outcome of EUS-guided choledochoduodenostomy in four patients who failed in ERCP. We performed the procedure in 2 papilla of Vater, including one resectable case, and 2 cases of cancer of the head of pancreas. Using a curved linear array echoendoscope, a 19 G needle or a needle knife was punctured transduodenally into the bile duct under EUS visualization. Using a biliary catheter for dilation, or papillary balloon dilator, a 7-Fr plastic stent was inserted through the choledochoduodenostomy site into the extrahepatic bile duct. In 3 (75%) of 4 cases, an indwelling plastic stent was placed, and in one case in which the stent could not be advanced into the bile duct, a naso-biliary drainage tube was placed instead. In all cases, the obstructive jaundice rapidly improved after the procedure. Focal peritonitis and bleeding not requiring blood transfusion was seen in one case. In this case, pancreatoduodenectomy was performed and the surgical findings revealed severe adhesion around the choledochoduodenostomy site. Although further studies and development of devices are mandatory, EUS-guided choledochoduodenostomy appears to be an effective alternative to ERCP in selected cases.

Keywords: Endoscopic ultrasonography-guided fine needle aspiration; Biliary drainage; Endoscopic retrograde cholangiopancreatography