P-THER-04: Outcome of endoscopic ultrasound-guided choledochoduodenostomy as rescue treatment after failed endoscopic retrograde cholangiopancreatography in mid and lower end common bile duct block

BACKGROUND AND OBJECTIVES: Endoscopic ultrasound (EUS)-guided biliary drainage is novel technique for biliary drainage after failed ERCP. The aim of the present study is to report the outcomes of EUS-guided biliary drainage after failed ERCP due to inaccessible papilla due to duodenal infiltration. METHODS: Data of all the patients who underwent choledochoduodenostomy form April 2014 to September 2016 were collected. Suprapancreatic common bile duct (CBD) was punctured transduodenally with a 19-gauge needle, needle tract was dilated using 6F cystotome, and a fully covered self-expanding metal stent was placed into the CBD. Complications during procedure and follow-up were recorded. RESULTS: Ten patients underwent EUS-guided choledochoduodenostomy. Seven patients had pancreatic cancer, two had carcinoma gall bladder with mid CBD block by metastatic lymph nodes, and one had ampullary carcinoma. Mean bilirubin was 16.4 mg/dL (± 3.2 mg/dL). Procedure could be performed successfully in all ten patients. Jaundice improved in all the patients, except one who had liver metastasis. No procedure-related complication was noticed. Bilirubin decreased to 1.8 mg/dl (± 1.4 mg/dL) at 1-month follow-up. After a mean follow-up of 8 months (± 2 months), survival was 70%, three patients died of underlying malignancy, one patient had stent migration in duodenal lumen, which was taken out, and plastic stent placed through the patent choledochoduodenal fistula. CONCLUSION: EUS-guided choledochoduodenostomy is a safe and effective alternative biliary drainage in patients with mid and lower end malignant CBD block.