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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