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

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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.

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Abbreviations

EUS-BD:

Endoscopic ultrasound-guided biliary drainage

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Authors and Affiliations

  1. Gastroenterology and Nutrition Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, P.O. Box 273, New York, NY, 10065, USA

    Paul J. Belletrutti, Christopher J. DiMaio, Hans Gerdes & Mark A. Schattner

Authors
  1. Paul J. Belletrutti
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  2. Christopher J. DiMaio
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  3. Hans Gerdes
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  4. Mark A. Schattner
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Correspondence to Mark A. Schattner.

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Belletrutti, P.J., DiMaio, C.J., Gerdes, H. et al. Endoscopic Ultrasound Guided Biliary Drainage in Patients with Unapproachable Ampullae Due to Malignant Duodenal Obstruction. J Gastrointest Canc 42, 137–142 (2011). https://doi.org/10.1007/s12029-010-9175-7

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  • DOI: https://doi.org/10.1007/s12029-010-9175-7

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