Successful Endoscopic Ultrasound-Guided Transduodenal Biliary Drainage Through a Pre-Existing Duodenal Stent
Abstract
Context When ERCP fails in the setting of combined biliary and duodenal obstruction, EUS-guided biliary drainage has emerged as an alternate method of biliary decompression. Case report We present a case of a 40-year-old man with advanced pancreatic cancer and a pre-existing duodenal wall stent who subsequently develops jaundice due to biliary obstruction. An ERCP was technically unsuccessful as the papilla was inaccessible despite probing within the duodenal stent. Transduodenal biliary drainage was achieved using EUS guidance to create a choledochoduodenostomy tract. A fully covered metal biliary stent was then deployed through the mesh of the duodenal wall stent. The patient’s jaundice and pruritus subsequently resolved. Conclusion This is the first report of successful transduodenal EUS-guided biliary drainage performed through an existing enteral wall stent and can still be considered as an alternate mode of biliary drainage in this setting.
Image: Deployed metal biliary stent protruding through mesh of duodenal wall stent.
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References
Maire F, Hammel P, Ponsot P, Aubert A, O'Toole D, Hentic O, Levy P, Ruszniewski P. Long-term outcome of biliary and duodenal stents in palliative treatment of patients with unresectable adenocarcinoma of the head of the pancreas. Am J Gastroenterol 2006; 101:735-42. [PMID 16635221]
Vanbiervliet G, Demarquay JF, Dumas R, Caroli-Bosc FX, Piche T, Tran A. Endoscopic insertion of biliary stents in 18 patients with metallic duodenal stents who developed secondary malignant obstructive jaundice. Gastroenterol Clin Biol 2004; 28:1209-13. [PMID 15671930]
Topazian M, Baron TH. Endoscopic fenestration of duodenal stents using argon plasma to facilitate ERCP. Gastrointest Endosc 2009; 69:166-9. [PMID 19111700]
Park DH, Koo JE, Oh J, Lee YH, Moon SH, Lee SS, et al. EUS-guided biliary drainage with one-step placement of a fully covered metal stent for malignant biliary obstruction: a prospective feasibility study. Am J Gastroenterol 2009; 104:2168-74. [PMID 19513026]
Yamao K, Bhatia V, Mizuno N, Sawaki A, Ishikawa H, Tajika M, et al. EUS-guided choledochoduodenostomy for palliative biliary drainage in patients with malignant biliary obstruction: results of long-term follow-up. Endoscopy 2008; 40:340-2. [PMID 18389451]
Taratino I, Barresi L, Repici A, Traina M. EUS-guided biliary drainage: a case series. Endoscopy 2008; 40:336-9. [PMID 18264890]
Will U, Thieme A, Fueldner F, Gerlach R, Waznar I, Meyer F. Treatment of biliary obstruction in selected patients by endoscopic ultrasonography (EUS)-guided transluminal biliary drainage. Endoscopy 2007; 39:292-5. [PMID 17357950]
Copyright (c) 2010 Paul J Belletrutti, Hans Gerdes, Mark A Schattner
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