title: Endoscopic ultrasonography-guided biliary drainage: evaluation of a choledochoduodenostomy technique.
abstract: BACKGROUND
  Endoscopic ultrasonography (EUS)-guided choledochoduodenostomy (CDS) is as an alternative to percutaneous transhepatic biliary drainage (PTBD) in patients with biliary obstruction when endoscopic retrograde biliary drainage (ERBD) is unsuccessful.
  
  
  OBJECTIVE
  We reviewed our experience and technique in patients undergoing EUS-CDS.
  
  
  METHODS
  Over a 2-year period to December 2008, 15 patients with unsuccessful ERBD underwent EUS-CDS.
  
  
  METHODS
  EUS-guided needle puncture was performed to access the bile duct from the duodenal bulb. After cholangiography, a guidewire was inserted through the needle and directed to the hepatic hilum. The punctured fistula was then dilated with a biliary dilator and a plastic stent was inserted.
  
  
  RESULTS
  The technical success rate of EUS-CDS was 93% (14/15 patients); 1 patient underwent an EUS-guided rendezvous approach because the choledochoduodenal fistula could not be dilated. Decompression of the bile duct was achieved in all patients. Complications included cholangitis in 4 patients, self-limiting local peritonitis in 2 and distal stent migration in 1 patient. The median follow-up time was 125 days and the median duration of stent patency was 99 days.
  
  
  CONCLUSIONS
  EUS-CDS may be effective for patients following unsuccessful ERBD and offers an attractive alternative to PTBD.
authors.affiliation: Department of Gastroenterology and Hepatology, Kinki University School of Medicine, Osakasayama, Japan.
authors.forename: Takamitsu
authors.initials: T
authors.lastname: Komaki
authors.forename: Masayuki
authors.initials: M
authors.lastname: Kitano
authors.forename: Hiroki
authors.initials: H
authors.lastname: Sakamoto
authors.forename: Masatoshi
authors.initials: M
authors.lastname: Kudo
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001658:Biliary Fistula / Q000601:surgery; D002768:Choledochostomy / Q000379:methods*; D002779:Cholestasis / Q000601:surgery*; D004322:Drainage / Q000379:methods*; D019160:Endosonography / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000150:complications; D015607:Stents; D018084:Ultrasonography, Interventional