Endoscopic ultrasound-guided choledochoduodenostomies with fully covered self-expandable metallic stents

• Published in: World journal of gastroenterology : WJG Vol. 18; no. 32; pp. 4435 - 4440
• Main Authors: Song, Tae Jun, Hyun, Yil Sik, Lee, Sang Soo, Park, Do Hyun, Seo, Dong Wan, Lee, Sung Koo, Kim, Myung-Hwan
• Format: Journal Article
• Language: English
• Published: United States Baishideng Publishing Group Co., Limited 28.08.2012
• Subjects: Adult; Aged; Aged, 80 and over; Bile Duct Neoplasms - diagnostic imaging; Bile Duct Neoplasms - mortality; Bile Duct Neoplasms - surgery; Brief; Cholangiopancreatography, Endoscopic Retrograde; Choledochostomy - methods; Cholestasis - diagnostic imaging; Cholestasis - mortality; Cholestasis - surgery; Endoscopy, Gastrointestinal - methods; Endosonography - methods; Female; Follow-Up Studies; Humans; Kaplan-Meier Estimate; Male; Metals; Middle Aged; Palliative Care; Retrospective Studies; Stents; Treatment Failure; Treatment Outcome; 内镜; 完全覆盖; 引导; 肠吻合术; 胰腺癌; 覆膜; 超声; 金属支架; Drainage; Bile duct obstruction; Endosonography; Self-expandable metallic stent; Neoplasms
• ISSN: 1007-9327; 2219-2840
• DOI: 10.3748/wjg.v18.i32.4435

AIM：To investigate the long-term outcomes of endoscopic ultrasound-guided choledochoduodenostomy（EUS-CDS） with a fully covered self-expandable metallic stent（FCSEMS）.METHODS：From April 2009 to August 2010,15 patients with distal malignant biliary obstructions who were candidates for alternative techniques for biliary decompression due to a failed endoscopic retrograde cholangiopancreatography（ERCP） were included.These 15 patients consisted of 8 men and 7 women and had a median age of 61 years（range：30-91 years）.The underlying causes of the distal malignant biliary obstruction were pancreatic cancer（n = 9）,ampulla of Vater cancer（n = 2）,renal cell carcinoma（n = 1）,advanced gastric cancer（n = 1）,lymphoma（n = 1）,and duodenal cancer（n = 1）.RESULTS：The technical success rate of EUS-CDS with an FCSEMS was 86.7%（13/15）,and functional success was achieved in 100%（13/13） of those cases.In two patients,the EUS-CDS failed because an FCSEMS with a delivery device could not be passed into the common bile duct.The mean duration of stent patency was 264 d.Early adverse events developed in three patients（3/13,23.1%）,including self-limited pneumoperitoneum in two patients and cholangitis requiring stent reposition in one patient.During the follow-up period（median：186 d,range：52-388 d）,distal stent migration occurred in four patients（4/13,30.8%）.In 3 patients,the FCSEMS could be reinserted through the existing choledochoduodenal fistula tract.CONCLUSION：EUS-CDS with an FCSEMS is technically feasible and can lead to effective palliation of distal malignant biliary obstructions after failed ERCP.