title: Endoscopic ultrasound-guided transduodenal placement of a fully covered metal stent for palliative biliary drainage in patients with malignant biliary obstruction.
abstract: BACKGROUND
  Endoscopic ultrasound (EUS)-guided biliary drainage (EUSBD) has been described as a viable alternative to percutaneous transhepatic cholangiography (PTC) in patients in whom ERCP has been unsuccessful. The purpose of our study was to assess the utility of EUSBD using a newly released, fully covered, self-expanding, biliary metal stent (SEMS) for palliation in patients with an obstructing malignant biliary stricture.
  
  
  METHODS
  We collected data on all patients who presented with obstructive jaundice and who underwent transduodenal EUSBD after a failed ERCP. Eight patients presented with biliary obstruction from inoperable pancreatic cancer or cholangiocarcinoma. Reasons for failed ERCP were duodenum stenosis, high-grade malignant stenosis of the common bile duct, periampullary tumor infiltration, failure to access the common bile duct, and periampullary diverticulum. EUS was used to access the common bile duct from the duodenum after which a guidewire was advanced upwards toward the liver hilum. The metal stent was then advanced into the biliary tree. Technical success was defined as correct stent deployment across the duodenum. Clinical success was defined as serum bilirubin level decreased by 50% or more within 2 weeks after the stent placement.
  
  
  RESULTS
  Technical and clinical success was achieved in all eight patients. No stent malfunction or occlusion was observed. Complications included one case of duodenal perforation, which required surgery, and one case of self-limiting abdominal pain.
  
  
  CONCLUSIONS
  EUSBD with a fully covered SEMS in whom ERCP is unsuccessful is effective for palliation of biliary obstruction. The limitations of our study are that we had a small number of patients and a limited follow-up time.
authors.affiliation: Department of Internal Medicine, Dallas Veterans Affairs Medical Center, 4500 S. Lancaster Road (111B1), Dallas, TX 75216, USA. asiddiqu2004@yahoo.com
authors.forename: Ali A
authors.initials: AA
authors.lastname: Siddiqui
authors.forename: Jayaprakash
authors.initials: J
authors.lastname: Sreenarasimhaiah
authors.forename: Luis F
authors.initials: LF
authors.lastname: Lara
authors.forename: William
authors.initials: W
authors.lastname: Harford
authors.forename: Calvin
authors.initials: C
authors.lastname: Lee
authors.forename: Mohamad A
authors.initials: MA
authors.lastname: Eloubeidi
mesh_terms: D000368:Aged; D002760:Cholangiopancreatography, Endoscopic Retrograde; D020099:Coated Materials, Biocompatible; D015331:Cohort Studies; D004322:Drainage / Q000295:instrumentation / Q000379:methods; D004384:Duodenoscopy / Q000379:methods; D004724:Endoscopy / Q000379:methods*; D019160:Endosonography / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D041781:Jaundice, Obstructive / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery*; D008297:Male; D008670:Metals; D008875:Middle Aged; D010166:Palliative Care / Q000379:methods; D011446:Prospective Studies; D019919:Prosthesis Implantation / Q000379:methods; D018570:Risk Assessment; D015607:Stents; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D020099:Coated Materials, Biocompatible; D008670:Metals