Endoscopic ultrasound-guided choledochoduodenostomy for palliative biliary drainage in cases with inoperable pancreas head carcinoma.

BACKGROUND: Endoscopic transpapillary biliary drainage (EBD) or stenting is the gold standard treatment for inoperable malignant biliary obstruction. When the papilla cannot be traversed because of pyloric or duodenal stenosis, or the catheter cannot be introduced, or because of previous surgery, the usual alternative method is considered to be percutaneous transhepatic biliary drainage (PTBD). We herein report our experiences with four cases with inoperable pancreatic head carcinoma associated with obstructive jaundice treated by endoscopic ultrasonography-guided biliary drainage (EUS-BD).

METHODS: Between September 2006 and December 2007, methods of EUS-BD were performed in four cases with inoperable pancreas head carcinoma. In three out of four cases, EBD and PTBD were unsuccessful because of previous surgery, or duodenal stenosis, or nondilated intrahepatic bile ducts. In one case, although PTBD was successful, internal drainage could not be established.

RESULTS: EUS-BD was successful for all cases. The obstructed biliary system was successfully decompressed by the creation of a choledochoduodenal fistula and the insertion of a transduodenal biliary plastic stent. No complication was encountered in all cases.

CONCLUSIONS: EUS-BD may have the potential of replacing PTBD in cases with inoperable pancreatic head carcinoma associated with obstructive jaundice.