Endoscopic Ultrasound-Guided Choledochoduodenostomy for Biliary Drainage in Patients with Lower End Common Bile Duct Block: A Single-Center Experience

Objective: Endoscopic ultrasound (EUS)-guided biliary drainage is evolving as an alternative technique in patients with failed endoscopic retrograde cholangiopancreatography. The objective of this study was to find out the outcome of EUS-guided choledochoduodenostomy in patients with malignant mid and lower end biliary obstruction with inaccessible papilla presenting at our center. Methods: The present study was a single-center prospective observational study. Data of all the patients who underwent choledochoduodensotomy from January 2014 to December 2015 were recorded. Outcome measures were technical success and clinical success. Technical success was defined as successful placement of stent in the biliary system; clinical success was defined as 50% reduction in bilirubin at 2 weeks. Complications during the procedure and follow-up were recorded. Results: A total of 10 patients underwent EUS-guided choledochoduodenostomy. Cause of biliary obstruction was pancreatic cancer in eight patients, two patients had carcinoma gallbladder with mid-common bile duct (CBD) block due to compression by metastatic lymph nodes, and one patient had ampullary carcinoma. Mean bilirubin value was 16.4 mg/dL (±3.2 mg/dL). Technical and clinical success were 100% and 90%, respectively. No immediate procedure-related complication was noticed. Two patients had stent migration during the follow-up. Conclusion: EUS-guided choledochoduodenostomy is an effective and safe alternative for rescuing biliary drainage in patients with mid and lower end malignant CBD block with inaccessible papilla