title: Endoscopic ultrasound-guided choledochoduodenostomies with fully covered self-expandable metallic stents.
abstract: OBJECTIVE
  To investigate the long-term outcomes of endoscopic ultrasound-guided choledochoduodenostomy (EUS-CDS) with a fully covered self-expandable metallic stent (FCSEMS).
  
  
  METHODS
  From April 2009 to August 2010, 15 patients with distal malignant biliary obstructions who were candidates for alternative techniques for biliary decompression due to a failed endoscopic retrograde cholangiopancreatography (ERCP) were included. These 15 patients consisted of 8 men and 7 women and had a median age of 61 years (range: 30-91 years). The underlying causes of the distal malignant biliary obstruction were pancreatic cancer (n = 9), ampulla of Vater cancer (n = 2), renal cell carcinoma (n = 1), advanced gastric cancer (n = 1), lymphoma (n = 1), and duodenal cancer (n = 1).
  
  
  RESULTS
  The technical success rate of EUS-CDS with an FCSEMS was 86.7% (13/15), and functional success was achieved in 100% (13/13) of those cases. In two patients, the EUS-CDS failed because an FCSEMS with a delivery device could not be passed into the common bile duct. The mean duration of stent patency was 264 d. Early adverse events developed in three patients (3/13, 23.1%), including self-limited pneumoperitoneum in two patients and cholangitis requiring stent reposition in one patient. During the follow-up period (median: 186 d, range: 52-388 d), distal stent migration occurred in four patients (4/13, 30.8%). In 3 patients, the FCSEMS could be reinserted through the existing choledochoduodenal fistula tract.
  
  
  CONCLUSIONS
  EUS-CDS with an FCSEMS is technically feasible and can lead to effective palliation of distal malignant biliary obstructions after failed ERCP.
authors.affiliation: Department of Internal Medicine, Inje University Ilsan Paik Hospital, Koyang 411-706, South Korea.
authors.forename: Tae Jun
authors.initials: TJ
authors.lastname: Song
authors.forename: Yil Sik
authors.initials: YS
authors.lastname: Hyun
authors.forename: Sang Soo
authors.initials: SS
authors.lastname: Lee
authors.forename: Do Hyun
authors.initials: DH
authors.lastname: Park
authors.forename: Dong Wan
authors.initials: DW
authors.lastname: Seo
authors.forename: Sung Koo
authors.initials: SK
authors.lastname: Lee
authors.forename: Myung-Hwan
authors.initials: MH
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001650:Bile Duct Neoplasms / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D002760:Cholangiopancreatography, Endoscopic Retrograde; D002768:Choledochostomy / Q000379:methods*; D002779:Cholestasis / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D019160:Endosonography / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008670:Metals; D008875:Middle Aged; D010166:Palliative Care; D012189:Retrospective Studies; D015607:Stents; D017211:Treatment Failure; D016896:Treatment Outcome
chemical_list: D008670:Metals