title: A One-step Procedure by Using Linear Echoendoscope to Perform EUS-guided Choledochoduodenostomy and Duodenal Stenting in Patients with Irresectable Periampullary Cancer.
abstract: OBJECTIVE
  Endoscopic ultrasound-guided choledochoduodenostomy (EUS-CD) has become an alternative method after unsuccessful endoscopic retrograde cholangiopancreatography (ERCP) treatment. We present a case series study and its feasibility by using only a linear therapeutic channel echoendoscope to create both a biliary-enteral fistula and anatomic enteral recanalization.
  
  
  METHODS
  We presented seven cases of unresectable periampullary cancer with both biliary and duodenal obstruction. In these cases, the EUS-guided technique might be an alternative to double stenting (biliary and enteral) in the same procedure and equipment.
  
  
  RESULTS
  In all cases, the location of the biliary obstruction was in the distal common bile duct (CBD) and the grade of proximal dilation diameter varied from 15 mm to 20 mm. Two patients had type I (28.6%) and five had type II (71.4%) duodenal obstruction. Technical success of EUS-CD, by the stent placement, occurred in 100% of the cases. There were no early complications. Biliary drainage was effective clinically as well as in laboratory in 6 cases (6/7), by relieving obstructive jaundice and decreasing bilirubin levels.
  
  
  CONCLUSIONS
  EUS equipment may offer an alternative to double stenting in the same procedure and with palliative propose.
authors.affiliation: Department of Surgery, University of Sao Paulo (USP), Brazil.
authors.forename: Carolina
authors.initials: C
authors.lastname: Rebello
authors.affiliation: Department of Surgery, University of Sao Paulo (USP), Brazil.
authors.forename: Andre
authors.initials: A
authors.lastname: Bordini
authors.affiliation: Department of Surgery, University of Sao Paulo (USP), Brazil.
authors.forename: Andre
authors.initials: A
authors.lastname: Yoshida
authors.affiliation: Department of Surgery, University of Sao Paulo (USP), Brazil.
authors.forename: Bruno
authors.initials: B
authors.lastname: Viana
authors.affiliation: Department of Surgery, University of Sao Paulo (USP), Brazil.
authors.forename: Pedro E N
authors.initials: PE
authors.lastname: Ramos
authors.affiliation: Department of Surgery, University of Sao Paulo (USP), Brazil.
authors.forename: Jose P
authors.initials: JP
authors.lastname: Otoch
authors.affiliation: Department of Surgery, University of Sao Paulo (USP), Brazil.
authors.forename: Luiz Marcelo
authors.initials: LM
authors.lastname: Cirino
authors.affiliation: Department of Surgery, University of Sao Paulo (USP), Brazil.
authors.forename: Everson L A
authors.initials: EL
authors.lastname: Artifon
keywords: choledochoduodenostomy; endoscopic retrograde cholangiopancreatography; endoscopic ultrasound; periampullary cancer