Brief Article
Copyright ©2012 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. Aug 28, 2012; 18(32): 4435-4440
Published online Aug 28, 2012. doi: 10.3748/wjg.v18.i32.4435
Endoscopic ultrasound-guided choledochoduodenostomies with fully covered self-expandable metallic stents
Tae Jun Song, Yil Sik Hyun, Sang Soo Lee, Do Hyun Park, Dong Wan Seo, Sung Koo Lee, Myung-Hwan Kim
Tae Jun Song, Department of Internal Medicine, Inje University Ilsan Paik Hospital, Koyang 411-706, South Korea
Yil Sik Hyun, Sang Soo Lee, Do Hyun Park, Dong Wan Seo, Sung Koo Lee, Myung-Hwan Kim, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul 138-736, South Korea
Author contributions: Song TJ and Hyun YS contributed equally to this work; Song TJ was responsible for the study concept and design, analysis and interpretation of data, drafting of the manuscript, and final approval of the version to be published; Hyun YS was responsible for the study concept and design and the acquisition of data, and final approval of the version to be published; Lee SS was responsible for the study concept and design, acquisition of data and material support, analysis and interpretation of data, critical revision, and final approval of the version to be published; Park DH, Seo DW, Lee SK and Kim MH was responsible for the acquisition of data and material support.
Supported by The 2012 Inje University Research Grant
Correspondence to: Sang Soo Lee, MD, PhD, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, 388-1 Pungnap-2dong, Songpa-gu, Seoul 138-736, South Korea. ssleedr@amc.seoul.kr
Telephone: +82-2-30103180 Fax: +82-2-4760824
Received: June 7, 2012
Revised: August 16, 2012
Accepted: August 18, 2012
Published online: August 28, 2012
Abstract

AIM: To investigate the long-term outcomes of endoscopic ultrasound-guided choledochoduodenostomy (EUS-CDS) with a fully covered self-expandable metallic stent (FCSEMS).

METHODS: From April 2009 to August 2010, 15 patients with distal malignant biliary obstructions who were candidates for alternative techniques for biliary decompression due to a failed endoscopic retrograde cholangiopancreatography (ERCP) were included. These 15 patients consisted of 8 men and 7 women and had a median age of 61 years (range: 30-91 years). The underlying causes of the distal malignant biliary obstruction were pancreatic cancer (n = 9), ampulla of Vater cancer (n = 2), renal cell carcinoma (n = 1), advanced gastric cancer (n = 1), lymphoma (n = 1), and duodenal cancer (n = 1).

RESULTS: The technical success rate of EUS-CDS with an FCSEMS was 86.7% (13/15), and functional success was achieved in 100% (13/13) of those cases. In two patients, the EUS-CDS failed because an FCSEMS with a delivery device could not be passed into the common bile duct. The mean duration of stent patency was 264 d. Early adverse events developed in three patients (3/13, 23.1%), including self-limited pneumoperitoneum in two patients and cholangitis requiring stent reposition in one patient. During the follow-up period (median: 186 d, range: 52-388 d), distal stent migration occurred in four patients (4/13, 30.8%). In 3 patients, the FCSEMS could be reinserted through the existing choledochoduodenal fistula tract.

CONCLUSION: EUS-CDS with an FCSEMS is technically feasible and can lead to effective palliation of distal malignant biliary obstructions after failed ERCP.

Keywords: Bile duct obstruction, Drainage, Endosonography, Self-expandable metallic stent, Neoplasms