Endoscopic ultrasound-guided choledochoduodenostomy for treatment of ampullary cancer.

Abstract

We describe the case of a patient for whom choledochoduodenostomy was performed under endoscopic ultrasound (EUS) guidance as an alternative to percutaneous transhepatic biliary drainage (PTBD) for the treatment of obstructive jaundice. An 82-year-old man with ampullary cancer was considered operable, but he refused surgery. Endoscopic biliary drainage (EBD) with an 8.5-French plastic stent was performed 2 months later because of the development of obstructive jaundice. The EBD stent was occluded 5 months after the stent insertion, and EUS choledochoduodenostomy (EUS-CDS) was performed. Pneumoperitoneum occurred 1 day after the procedure, which resolved with conservative treatment. Six months later, multiple lymph node metastases occurred, and the patient was effectively treated by chemotherapy (S-1). The patient is still alive with a good quality of life more than 2 years after EUS-CDS. We conclude that EUS-CDS is an effective alternative to PTBD or EBD for patients with malignant biliary obstruction, especially due to ampullary cancer.

• Authors: Shigetaka Yoshinaga, Kenji Yamao, Vikram Vhatia, Nobumasa Mizuno, Akira Sawaki, Masahiro Tajika, Norimitu Ishii, Wael A Abbas, Yasuhiro Shimizu
• Journal: Clinical journal of gastroenterology (Clin J Gastroenterol) Vol. 2 Issue 1 Pg. 55-58 (Feb 2009) ISSN: 1865-7257 [Print] Japan
• PMID: 26191811 (Publication Type: Journal Article)