P-THER-21: Transluminal derivation of the biliary tract, obstructed by tumor: Coledocoduodenostomy guided by endoscopic ultrasound

We present the technique of transluminal coledocoduodenostomy for a distal tumoral injury of biliary tract and pancreas that was not permitted to perform CPRE. Our technique by steps is shown in the video, explaining with drawings and video which is performed. Steps: 1. Place the linear endosonograph in DI; 2. Locate the distal point dilated from the coledoco; 3. We do Doppler to discover vessels that interpong between the transducer and the biliary tract; 4. We make a punction in this case with Boston Scientific needle 19-gauge; 5. After the biliary punction, we suck to check that there is bilis; 6. Contrasting to draw the biliary route in its entirety and planning the type of stent; 7. We introduce a hydrophilic 0.035 Terumo guide; 8. Through this, we pass a cystotomy of W. Cook 6 Fr; 9. In this way, we dilate the tract between the duodenum lumen and the biliary tract; 10. Then, we pass a self-expandable covered stent, size of variable size according to the need; 11. Should leave four combined-modality therapy stents in the duodenal lumen, to avoid migration as possible; 12. At the end, we infect contrast with a CPRE occlusion balloon to verify the waterproofing of the stent.