Journal of Gastrointestinal Cancer

, Volume 42, Issue 3, pp 137–142

Endoscopic Ultrasound Guided Biliary Drainage in Patients with Unapproachable Ampullae Due to Malignant Duodenal Obstruction

  • Paul J. Belletrutti
  • Christopher J. DiMaio
  • Hans Gerdes
  • Mark A. Schattner
Original Research

DOI: 10.1007/s12029-010-9175-7

Cite this article as:
Belletrutti, P.J., DiMaio, C.J., Gerdes, H. et al. J Gastrointest Canc (2011) 42: 137. doi:10.1007/s12029-010-9175-7

Abstract

Purpose

When endoscopic retrograde cholangiopancreatography (ERCP) is not possible due to duodenal obstruction, endoscopic ultrasound-guided biliary drainage (EUS-BD) has emerged as an alternate mode of biliary decompression. This study aims to determine the safety and outcomes of performing EUS-BD in such patients.

Methods

A retrospective review of our endoscopy procedure database was carried out to identify patients with malignant biliary obstruction and failed ERCP in whom EUS-BD was attempted.

Results

Seven patients were identified. The technical success rate was 6/7 (86%). Four patients were treated with a choledochoduodenostomy; two had hepaticogastrostomies; drainage was not attempted in one due to unfavorable anatomy on EUS. In three patients, EUS-BD was performed immediately after unsuccessful ERCP as a single procedure. The initial choice of stent was plastic in two, self-expanding uncovered metal in two, and fully covered metal in two. The median follow-up was 15.5 weeks. There were no immediate complications. Bilirubin decreased in 5/6 (83%) and jaundice resolved in 4/6 (67%). Pruritus resolved in 4/4 (100%). Chemotherapy was restarted in 4/6 (67%). Reintervention due to stent blockage occurred twice. Both were converted to fully covered metal stents. No instances of stent migration were observed.

Conclusions

In our series, EUS-BD is a feasible, safe, and effective method of internal drainage in appropriately selected patients with biliary obstruction and unapproachable ampullae due to malignant duodenal obstruction. EUS-BD can be performed immediately after a failed ERCP under the same anesthesia. Covered metal stents may be preferred, but further study is required.

Keywords

endoscopic ultrasonography therapeutics cholangiography 

Non-standard abbreviations

EUS-BD

Endoscopic ultrasound-guided biliary drainage

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • Paul J. Belletrutti
    • 1
  • Christopher J. DiMaio
    • 1
  • Hans Gerdes
    • 1
  • Mark A. Schattner
    • 1
  1. 1.Gastroenterology and Nutrition Service, Department of MedicineMemorial Sloan-Kettering Cancer CenterNew YorkUSA