Endoscopic ultrasound guided biliary drainage in patients with unapproachable ampullae due to malignant duodenal obstruction Journal Article


Authors: Belletrutti, P. J.; Dimaio, C. J.; Gerdes, H.; Schattner, M. A.
Article Title: Endoscopic ultrasound guided biliary drainage in patients with unapproachable ampullae due to malignant duodenal obstruction
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. © Springer Science+Business Media, LLC 2010.
Keywords: adult; cancer chemotherapy; clinical article; treatment outcome; aged; middle aged; survival rate; treatment failure; retrospective studies; pancreatic neoplasms; outcome assessment; follow up; follow-up studies; antineoplastic agent; prospective studies; cancer palliative therapy; retrospective study; pruritus; bilirubin; patient safety; general anesthesia; jaundice; stent; biliary tract drainage; bilirubin blood level; drainage; endoscopic echography; endosonography; therapeutics; bare metal stent; cholangiography; stents; endoscopic retrograde cholangiopancreatography; cholangiopancreatography, endoscopic retrograde; endoscopy, gastrointestinal; choledochoduodenostomy; duodenum obstruction; abdominal cancer; endoscopic ultrasonography; malignant duodenal obstruction; duodenal neoplasms; duodenal obstruction
Journal Title: Journal of Gastrointestinal Cancer
Volume: 42
Issue: 3
ISSN: 1941-6628
Publisher: Springer  
Date Published: 2011-09-01
Start Page: 137
End Page: 142
Language: English
DOI: 10.1007/s12029-010-9175-7
PROVIDER: scopus
PUBMED: 20549387
DOI/URL:
Notes: --- - "Export Date: 9 December 2011" - "Source: Scopus"
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MSK Authors
  1. Christopher Dimaio
    17 Dimaio
  2. Hans Gerdes
    127 Gerdes
  3. Mark Schattner
    102 Schattner