Surgical Endoscopy

, Volume 25, Issue 2, pp 549–555

Endoscopic ultrasound-guided transduodenal placement of a fully covered metal stent for palliative biliary drainage in patients with malignant biliary obstruction

Authors

    • Department of Internal MedicineDallas Veterans Affairs Medical Center
    • Department of Medicine, Division of Gastroenterology and HepatologyUniversity of Texas Southwestern Medical School
  • Jayaprakash Sreenarasimhaiah
    • Department of Internal MedicineDallas Veterans Affairs Medical Center
    • Department of Medicine, Division of Gastroenterology and HepatologyUniversity of Texas Southwestern Medical School
  • Luis F. Lara
    • Departments of Internal MedicineBaylor Medical Center
  • William Harford
    • Department of Internal MedicineDallas Veterans Affairs Medical Center
    • Department of Medicine, Division of Gastroenterology and HepatologyUniversity of Texas Southwestern Medical School
  • Calvin Lee
    • Department of Internal MedicineDallas Veterans Affairs Medical Center
  • Mohamad A. Eloubeidi
    • Department of Medicine, Division of Gastroenterology and HepatologyThe University of Alabama at Birmingham
Article

DOI: 10.1007/s00464-010-1216-6

Cite this article as:
Siddiqui, A.A., Sreenarasimhaiah, J., Lara, L.F. et al. Surg Endosc (2011) 25: 549. doi:10.1007/s00464-010-1216-6

Abstract

Background

Endoscopic ultrasound (EUS)-guided biliary drainage (EUSBD) has been described as a viable alternative to percutaneous transhepatic cholangiography (PTC) in patients in whom ERCP has been unsuccessful. The purpose of our study was to assess the utility of EUSBD using a newly released, fully covered, self-expanding, biliary metal stent (SEMS) for palliation in patients with an obstructing malignant biliary stricture.

Methods

We collected data on all patients who presented with obstructive jaundice and who underwent transduodenal EUSBD after a failed ERCP. Eight patients presented with biliary obstruction from inoperable pancreatic cancer or cholangiocarcinoma. Reasons for failed ERCP were duodenum stenosis, high-grade malignant stenosis of the common bile duct, periampullary tumor infiltration, failure to access the common bile duct, and periampullary diverticulum. EUS was used to access the common bile duct from the duodenum after which a guidewire was advanced upwards toward the liver hilum. The metal stent was then advanced into the biliary tree. Technical success was defined as correct stent deployment across the duodenum. Clinical success was defined as serum bilirubin level decreased by 50% or more within 2 weeks after the stent placement.

Results

Technical and clinical success was achieved in all eight patients. No stent malfunction or occlusion was observed. Complications included one case of duodenal perforation, which required surgery, and one case of self-limiting abdominal pain.

Conclusions

EUSBD with a fully covered SEMS in whom ERCP is unsuccessful is effective for palliation of biliary obstruction. The limitations of our study are that we had a small number of patients and a limited follow-up time.

Keywords

Pancreato Bilio Cancer Digestive Instruments Technical Ultrasonography G-I Endoscopy

Copyright information

© Springer Science+Business Media, LLC 2010