Endoscopic ultrasonography (EUS)-guided biliary drainage was performed for treatment of patients who have
obstructive jaundice in cases of failed endoscopic retrograde cholangiopancreatography (ERCP). In the present study, we introduced the feasibility and outcome of EUS-guided
choledochoduodenostomy in four patients who failed in ERCP. We performed the procedure in 2 papilla of Vater, including one resectable case, and 2 cases of
cancer of the head of pancreas. Using a curved linear array echoendoscope,
a 19 G needle or a needle knife was punctured transduodenally into the bile duct under EUS visualization. Using a biliary
catheter for dilation, or papillary balloon dilator, a 7-Fr
plastic stent was inserted through the
choledochoduodenostomy site into the extrahepatic bile duct. In 3 (75%) of 4 cases, an indwelling
plastic stent was placed, and in one case in which the
stent could not be advanced into the bile duct, a naso-biliary drainage tube was placed instead. In all cases, the
obstructive jaundice rapidly improved after the procedure. Focal
peritonitis and
bleeding not requiring
blood transfusion was seen in one case. In this case,
pancreatoduodenectomy was performed and the surgical findings revealed severe adhesion around the
choledochoduodenostomy site. Although further studies and development of devices are mandatory, EUS-guided
choledochoduodenostomy appears to be an effective alternative to ERCP in selected cases.