How about the feasibility of endoscopic ultrasonography-guided choledochoduodenostomy?

Endoscopic ultrasonography (EUS)-guided biliary drainage for treatment of patients who have obstructive jaundice in cases of failed endoscopic retrograde cholangiopancreatography (ERCP).

An article published on 21 October 2008 in the World Journal of Gastroenterology addresses the case. The research team led by Takao Itoi, from Tokyo Medical University Shinjuku-ku of Japan introduced the feasibility and outcome of EUS-guided choledochoduodenostomy in four patients who failed ERCP.

They performed the procedure in 2 papilla of Vater, including one resectable case, and 2 cases of cancer of the head of pancreas were applied for this procedure. Using a curved linear array echoendoscope, a 19 G needle or a needle knife was punctured transduodenally into the bile duct under EUS visualisation. After 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 of 4 (75%) 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 cases. In this case, pancreatoduodenectomy was perfomed and the surgical findings revealed that severe adhesion around the choledochoduodenostomy site was recognised. Although further studies and development of devices are mandatory, EUS-guided choledochoduodenostomy may appear to be an effective alternative to ERCP in selected cases.