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

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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.

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Disclosures

Drs. Ali A. Siddiqui, Jayaprakash Sreenarasimhaiah, Luis F. Lara, William Harford, Calvin Lee, and Mohamad A. Eloubeidi have no conflicts of interest or financial ties to disclose. This study was performed with departmental funds.

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Authors and Affiliations

  1. Department of Internal Medicine, Dallas Veterans Affairs Medical Center, 4500 S. Lancaster Road (111B1), Dallas, TX, 75216, USA

    Ali A. Siddiqui, Jayaprakash Sreenarasimhaiah, William Harford & Calvin Lee

  2. Department of Medicine, Division of Gastroenterology and Hepatology, University of Texas Southwestern Medical School, Dallas, TX, USA

    Ali A. Siddiqui, Jayaprakash Sreenarasimhaiah & William Harford

  3. Departments of Internal Medicine, Baylor Medical Center, Dallas, TX, USA

    Luis F. Lara

  4. Department of Medicine, Division of Gastroenterology and Hepatology, The University of Alabama at Birmingham, Birmingham, AL, USA

    Mohamad A. Eloubeidi

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  1. Ali A. Siddiqui
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  2. Jayaprakash Sreenarasimhaiah
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  3. Luis F. Lara
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  4. William Harford
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  5. Calvin Lee
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Correspondence to Ali A. Siddiqui.

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Siddiqui, A.A., Sreenarasimhaiah, J., Lara, L.F. et al. Endoscopic ultrasound-guided transduodenal placement of a fully covered metal stent for palliative biliary drainage in patients with malignant biliary obstruction. Surg Endosc 25, 549–555 (2011). https://doi.org/10.1007/s00464-010-1216-6

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  • DOI: https://doi.org/10.1007/s00464-010-1216-6

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