title: Endoscopic ultrasonography-guided cholecystogastrostomy using a lumen-apposing metal stent as an alternative to extrahepatic bile duct drainage in pancreatic cancer with duodenal invasion.
abstract: Various approaches to biliary drainage, especially endoscopic ultrasonography (EUS)-guided drainage, have become commonly used as an alternative method for biliary decompression for malignant biliary obstruction. Occasionally, however, duodenal obstruction and non-dilated intrahepatic bile duct impede conventional EUS-guided biliary drainage. Herein, we describe a case of cholecystogastrostomy successfully carried out using a newly developed fully covered lumen-apposing self-expandable metallic stent (SEMS). EUS-guided cholecystogastrostomy should be considered an option for biliary decompression. This is a particularly ideal alternative if the patient has duodenal strictures with or without a duodenal metal stent and a non-dilated intrahepatic bile duct, which suggests the impossibility of choledochoduodenostomy and hepaticogastrostomy. Furthermore, the newly developed fully covered lumen-apposing SEMS seems ideal for EUS-guided cholecystoenterostomy.
authors.affiliation: Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan. itoi@tokyo-med.ac.jp
authors.forename: Takao
authors.initials: T
authors.lastname: Itoi
authors.forename: Kenneth
authors.initials: K
authors.lastname: Binmoeller
authors.forename: Fumihide
authors.initials: F
authors.lastname: Itokawa
authors.forename: Junko
authors.initials: J
authors.lastname: Umeda
authors.forename: Reina
authors.initials: R
authors.lastname: Tanaka
mesh_terms: D017734:Bile Ducts, Extrahepatic / Q000000981:diagnostic imaging / Q000601:surgery*; D002760:Cholangiopancreatography, Endoscopic Retrograde; D002767:Cholecystostomy / Q000379:methods*; D004379:Duodenal Neoplasms / Q000473:pathology* / Q000601:surgery; D019160:Endosonography / Q000379:methods*; D005500:Follow-Up Studies; D005774:Gastrostomy / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D010190:Pancreatic Neoplasms / Q000473:pathology / Q000601:surgery*; D011474:Prosthesis Design; D015607:Stents