title: EUS-guided transduodenal biliary drainage in unresectable pancreatic cancer with obstructive jaundice.
abstract: BACKGROUND
  Endoscopic transpapillary biliary drainage is the procedure of choice for biliary decompression in patients with unresectable pancreatic cancer. When ERCP is unsuccessful, the usual alternative is percutaneous transhepatic biliary drainage. Recently, the use of EUS-guided biliary drainage has been reported, but it is not clear whether it is feasible for this technique to find more widespread use as an alternative to failed ERCP. We herein describe our experience with two cases of unresectable pancreatic cancer associated with obstructive jaundice treated by EUS-guided biliary drainage.
  
  
  METHODS
  Two men presented with obstructive jaundice due to unresectable pancreatic cancer. ERCP was unsuccessful in both cases because of complete tumor obstruction at the distal common bile duct. Both patients rejected the standard option of percutaneous transhepatic biliary drainage and EUS-guided biliary drainage was performed. The obstructed biliary system was successfully decompressed by the creation of a choledochoduodenal fistula and the insertion of a transduodenal biliary stent.
  
  
  CONCLUSIONS
  EUS-guided biliary drainage has the potential of replacing percutaneous transhepatic biliary drainage in unresectable pancreatic cancer with obstructive jaundice when ERCP is unsuccessful.
authors.affiliation: Division of Gastroenterology, Department of Medicine, Changi General Hospital, Singapore, Singapore. tiing_leong_ang@cgh.com.sg
authors.forename: Tiing Leong
authors.initials: TL
authors.lastname: Ang
authors.forename: Eng Kiong
authors.initials: EK
authors.lastname: Teo
authors.forename: Kwong Ming
authors.initials: KM
authors.lastname: Fock
mesh_terms: D000230:Adenocarcinoma / Q000150:complications*; D000369:Aged, 80 and over; D002768:Choledochostomy; D002779:Cholestasis / Q000601:surgery*; D004322:Drainage / Q000379:methods*; D004386:Duodenum / Q000000981:diagnostic imaging; D019160:Endosonography; D006801:Humans; D041781:Jaundice, Obstructive / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000150:complications*; D018084:Ultrasonography, Interventional