title: Successful endoscopic ultrasound-guided transduodenal biliary drainage through a pre-existing duodenal stent.
abstract: BACKGROUND
  When ERCP fails in the setting of combined biliary and duodenal obstruction, EUS-guided biliary drainage has emerged as an alternate method of biliary decompression.
  
  
  METHODS
  We present a case of a 40-year-old man with advanced pancreatic cancer and a pre-existing duodenal wall stent who subsequently develops jaundice due to biliary obstruction. An ERCP was technically unsuccessful as the papilla was inaccessible despite probing within the duodenal stent. Transduodenal biliary drainage was achieved using EUS guidance to create a choledochoduodenostomy tract. A fully covered metal biliary stent was then deployed through the mesh of the duodenal wall stent. The patient's jaundice and pruritus subsequently resolved.
  
  
  CONCLUSIONS
  This is the first report of successful transduodenal EUS-guided biliary drainage performed through an existing enteral wall stent and can still be considered as an alternate mode of biliary drainage in this setting.
authors.affiliation: Gastroenterology and Nutrition Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Belletrutti
authors.forename: Hans
authors.initials: H
authors.lastname: Gerdes
authors.forename: Mark A
authors.initials: MA
authors.lastname: Schattner
mesh_terms: D000328:Adult; D002760:Cholangiopancreatography, Endoscopic Retrograde; D002768:Choledochostomy; D002779:Cholestasis / Q000000981:diagnostic imaging / Q000601:surgery*; D004322:Drainage / Q000379:methods*; D004386:Duodenum; D006801:Humans; D041781:Jaundice, Obstructive / Q000000981:diagnostic imaging / Q000601:surgery; D008297:Male; D010190:Pancreatic Neoplasms / Q000150:complications*; D015607:Stents; D018084:Ultrasonography, Interventional