Endoscopic ultrasound-guided choledochoduodenostomy and duodenal stenting in patients with unresectable periampullary cancer: one-step procedure by using linear echoendoscope.
OBJECTIVE
Describe a case series of endoscopic ultrasound (EUS)-guided choledochoduodenostomy (EUS-CD) associated with duodenal self-expandable metal stents (SEMS) placement using solely the linear echoendoscope in seven patients with obstructive jaundice and duodenal obstruction due to unresectable periampullary cancer.


METHODS
EUS-CD in the first portion of the duodenum, associated with duodenal SEMS placement was performed in seven patients with unresectable periampullary cancer with obstructive jaundice and invasive duodenal obstruction. Laboratory tests and clinical follow-up were performed until patient's death. The procedure was performed by an experienced endoscopist under conscious sedation. The puncture position was chosen based on EUS evaluation, at the common bile duct (CBD) above the tumor, through the distal part of the duodenal bulb. After that, the needle was withdrawn and a wire-guided needle knife was used to enlarge the site puncture in the duodenal wall. Then, a partially covered SEMS was passed over the guide, through the choledochoduodenal fistula. Duodenal SEMS placement was performed during the same endoscopic procedure.


RESULTS
The procedure was performed in seven patients, ranging between 34 and 86 years. Technical success of EUS-CD, by the stent placement, occurred in 100% of the cases. There were no early complications. Duodenal SEMS placement was effective in 100% of the cases that remained alive after a follow-up of 7 and 30 days.


CONCLUSIONS
The results suggest therapeutic EUS one-step procedure drainage as an alternative for these patients, with good clinical success, feasible technique and safety.
Gastrointestinal Endoscopy Unit, University of São Paulo Medical School, São Paulo, Brazil. eartifon@hotmail.com
Everson L A
EL
Artifon
Mariana S V
MS
Frazão
Stephanie
S
Wodak
Fred Olavo A A
FO
Carneiro
Jonas
J
Takada
Carolina
C
Rabello
Dayse
D
Aparício
Eduardo Guimarães Hourneaux
EG
de Moura
Paulo
P
Sakai
José Pinhata
JP
Otoch
D000230:Adenocarcinoma / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014670:Ampulla of Vater / Q000601:surgery*; D002768:Choledochostomy / Q000295:instrumentation / Q000379:methods*; D003138:Common Bile Duct Neoplasms / Q000601:surgery*; D004322:Drainage; D004386:Duodenum; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010166:Palliative Care; D010190:Pancreatic Neoplasms / Q000601:surgery*; D015607:Stents; D018084:Ultrasonography, Interventional / Q000295:instrumentation / Q000379:methods*