Clinical Outcomes of EUS-Guided Choledochoduodenostomy for Biliary Drainage in Unresectable Pancreatic Cancer: A Case Series
<i>Introduction.</i> Pancreatic ductal adenocarcinoma (PDA) is associated with poor prognosis and 98% loss-of-life expectancy. 80% of patients with PDA are unfit for radical surgery. In those cases, emphasis is set on management of cancer-related symptoms, among which obstructive jaundic...
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MDPI AG
2023-02-01
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| Series: | Medicina |
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| Online Access: | https://www.mdpi.com/1648-9144/59/2/351 |
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| author | Bozhidar Hristov Deyan Radev Petar Uchikov Gancho Kostov Mladen Doykov Siyana Valova Eduard Tilkiyan |
| author_facet | Bozhidar Hristov Deyan Radev Petar Uchikov Gancho Kostov Mladen Doykov Siyana Valova Eduard Tilkiyan |
| author_sort | Bozhidar Hristov |
| collection | DOAJ |
| description | <i>Introduction.</i> Pancreatic ductal adenocarcinoma (PDA) is associated with poor prognosis and 98% loss-of-life expectancy. 80% of patients with PDA are unfit for radical surgery. In those cases, emphasis is set on management of cancer-related symptoms, among which obstructive jaundice is most common. Endoscopic ultrasound-guided biliary drainage (EUS-BD) emerges as a valid alternative to the well-accepted methods for treatment of biliary obstruction. <i>Patient Selection.</i> Five consecutive patients with unresectable pancreatic malignancy, were subjected to EUS-BD, particularly EUS-guided choledochoduodenostomy (EUS-CDS). <i>Ethics.</i> Oral and written informed consent was obtained in all cases prior procedure. <i>Technique.</i> EUS-guided puncture of the common bile duct was performed, followed by advancement of a guidewire to the intrahepatic bile ducts. After dilation of the fistulous tract with a cystotome, a fully covered self-expandable metal stent was inserted below the hepatic confluence and extending at least 3 cm in the duodenum. Technical and clinical success was achieved in four patients without adverse events. In one patient procedure failed due to dislocation of the guidewire, with consequent biliary leakage requiring urgent surgery. Recovery was uneventful with no further clinical sequelae and there was no mortality associated with procedure. <i>Discussion.</i> Introduced in 2001, EUS-guided biliary drainage has become an accepted option for treatment of obstructive jaundice. According to recent guidelines published by European Society of Gastrointestinal Endoscopy (ESGE) in 2022, EUS-CDS is a preferred modality to percutaneous transhepatic biliary drainage (PTBD) and surgery in patients with failed ERCP, with comparable efficiency and better safety profile, which is supported by our experience with the procedure. <i>Conclusions.</i> Our case series suggests that EUS-CDS is an excellent option for palliative management of malignant distal biliary obstruction, emphasizes on the importance of adequate technique and experience for the technical success, and urges the need for future research on establishing the best choice for guidewire and dilation device. |
| first_indexed | 2024-03-11T08:27:18Z |
| format | Article |
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| institution | Directory Open Access Journal |
| issn | 1010-660X 1648-9144 |
| language | English |
| last_indexed | 2024-03-11T08:27:18Z |
| publishDate | 2023-02-01 |
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| series | Medicina |
| spelling | doaj.art-687f6315b571459c91ce241ba3347e112023-11-16T22:00:35ZengMDPI AGMedicina1010-660X1648-91442023-02-0159235110.3390/medicina59020351Clinical Outcomes of EUS-Guided Choledochoduodenostomy for Biliary Drainage in Unresectable Pancreatic Cancer: A Case SeriesBozhidar Hristov0Deyan Radev1Petar Uchikov2Gancho Kostov3Mladen Doykov4Siyana Valova5Eduard Tilkiyan6Second Department of Internal Diseases, Section “Gastroenterology”, Medical Faculty, Medical University of Plovdiv, 6000 Plovdiv, BulgariaSecond Department of Internal Diseases, Section “Gastroenterology”, Medical Faculty, Medical University of Plovdiv, 6000 Plovdiv, BulgariaDepartment of Special Surgery, Faculty of Medicine, Medical University of Plovdiv, 6000 Plovdiv, BulgariaDepartment of Special Surgery, Faculty of Medicine, Medical University of Plovdiv, 6000 Plovdiv, BulgariaDepartment of Urology and General Medicine, Medical Faculty, Medical University of Plovdiv, 6000 Plovdiv, BulgariaSecond Department of Internal Diseases, Section “Nephrology”, Medical Faculty, Medical University of Plovdiv, 6000 Plovdiv, BulgariaSecond Department of Internal Diseases, Section “Nephrology”, Medical Faculty, Medical University of Plovdiv, 6000 Plovdiv, Bulgaria<i>Introduction.</i> Pancreatic ductal adenocarcinoma (PDA) is associated with poor prognosis and 98% loss-of-life expectancy. 80% of patients with PDA are unfit for radical surgery. In those cases, emphasis is set on management of cancer-related symptoms, among which obstructive jaundice is most common. Endoscopic ultrasound-guided biliary drainage (EUS-BD) emerges as a valid alternative to the well-accepted methods for treatment of biliary obstruction. <i>Patient Selection.</i> Five consecutive patients with unresectable pancreatic malignancy, were subjected to EUS-BD, particularly EUS-guided choledochoduodenostomy (EUS-CDS). <i>Ethics.</i> Oral and written informed consent was obtained in all cases prior procedure. <i>Technique.</i> EUS-guided puncture of the common bile duct was performed, followed by advancement of a guidewire to the intrahepatic bile ducts. After dilation of the fistulous tract with a cystotome, a fully covered self-expandable metal stent was inserted below the hepatic confluence and extending at least 3 cm in the duodenum. Technical and clinical success was achieved in four patients without adverse events. In one patient procedure failed due to dislocation of the guidewire, with consequent biliary leakage requiring urgent surgery. Recovery was uneventful with no further clinical sequelae and there was no mortality associated with procedure. <i>Discussion.</i> Introduced in 2001, EUS-guided biliary drainage has become an accepted option for treatment of obstructive jaundice. According to recent guidelines published by European Society of Gastrointestinal Endoscopy (ESGE) in 2022, EUS-CDS is a preferred modality to percutaneous transhepatic biliary drainage (PTBD) and surgery in patients with failed ERCP, with comparable efficiency and better safety profile, which is supported by our experience with the procedure. <i>Conclusions.</i> Our case series suggests that EUS-CDS is an excellent option for palliative management of malignant distal biliary obstruction, emphasizes on the importance of adequate technique and experience for the technical success, and urges the need for future research on establishing the best choice for guidewire and dilation device.https://www.mdpi.com/1648-9144/59/2/351pancreatic cancerendoscopic ultrasoundbiliary drainagecholedochoduodenostomy |
| spellingShingle | Bozhidar Hristov Deyan Radev Petar Uchikov Gancho Kostov Mladen Doykov Siyana Valova Eduard Tilkiyan Clinical Outcomes of EUS-Guided Choledochoduodenostomy for Biliary Drainage in Unresectable Pancreatic Cancer: A Case Series Medicina pancreatic cancer endoscopic ultrasound biliary drainage choledochoduodenostomy |
| title | Clinical Outcomes of EUS-Guided Choledochoduodenostomy for Biliary Drainage in Unresectable Pancreatic Cancer: A Case Series |
| title_full | Clinical Outcomes of EUS-Guided Choledochoduodenostomy for Biliary Drainage in Unresectable Pancreatic Cancer: A Case Series |
| title_fullStr | Clinical Outcomes of EUS-Guided Choledochoduodenostomy for Biliary Drainage in Unresectable Pancreatic Cancer: A Case Series |
| title_full_unstemmed | Clinical Outcomes of EUS-Guided Choledochoduodenostomy for Biliary Drainage in Unresectable Pancreatic Cancer: A Case Series |
| title_short | Clinical Outcomes of EUS-Guided Choledochoduodenostomy for Biliary Drainage in Unresectable Pancreatic Cancer: A Case Series |
| title_sort | clinical outcomes of eus guided choledochoduodenostomy for biliary drainage in unresectable pancreatic cancer a case series |
| topic | pancreatic cancer endoscopic ultrasound biliary drainage choledochoduodenostomy |
| url | https://www.mdpi.com/1648-9144/59/2/351 |
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