title: Endoscopic ultrasound-guided choledochoduodenostomy for treatment of ampullary cancer.
abstract: We describe the case of a patient for whom choledochoduodenostomy was performed under endoscopic ultrasound (EUS) guidance as an alternative to percutaneous transhepatic biliary drainage (PTBD) for the treatment of obstructive jaundice. An 82-year-old man with ampullary cancer was considered operable, but he refused surgery. Endoscopic biliary drainage (EBD) with an 8.5-French plastic stent was performed 2 months later because of the development of obstructive jaundice. The EBD stent was occluded 5 months after the stent insertion, and EUS choledochoduodenostomy (EUS-CDS) was performed. Pneumoperitoneum occurred 1 day after the procedure, which resolved with conservative treatment. Six months later, multiple lymph node metastases occurred, and the patient was effectively treated by chemotherapy (S-1). The patient is still alive with a good quality of life more than 2 years after EUS-CDS. We conclude that EUS-CDS is an effective alternative to PTBD or EBD for patients with malignant biliary obstruction, especially due to ampullary cancer.
authors.affiliation: Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan. yoshige@intmed3.med.kyushu-u.ac.jp.|Department of Gastroenterology, Aichi Cancer Center Hospital, Nagoya, Japan. yoshige@intmed3.med.kyushu-u.ac.jp.
authors.forename: Shigetaka
authors.initials: S
authors.lastname: Yoshinaga
authors.affiliation: Department of Gastroenterology, Aichi Cancer Center Hospital, Nagoya, Japan.
authors.forename: Kenji
authors.initials: K
authors.lastname: Yamao
authors.affiliation: Department of Gastroenterology, Aichi Cancer Center Hospital, Nagoya, Japan.|Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Vikram
authors.initials: V
authors.lastname: Vhatia
authors.affiliation: Department of Gastroenterology, Aichi Cancer Center Hospital, Nagoya, Japan.
authors.forename: Nobumasa
authors.initials: N
authors.lastname: Mizuno
authors.affiliation: Department of Gastroenterology, Aichi Cancer Center Hospital, Nagoya, Japan.
authors.forename: Akira
authors.initials: A
authors.lastname: Sawaki
authors.affiliation: Department of Gastroenterology, Aichi Cancer Center Hospital, Nagoya, Japan.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Tajika
authors.affiliation: Department of Gastroenterology, Aichi Cancer Center Hospital, Nagoya, Japan.
authors.forename: Norimitu
authors.initials: N
authors.lastname: Ishii
authors.affiliation: Department of Gastroenterology, Aichi Cancer Center Hospital, Nagoya, Japan.
authors.forename: Wael A
authors.initials: WA
authors.lastname: Abbas
authors.affiliation: Department of Gastrointestinal Surgery, Aichi Cancer Center Hospital, Nagoya, Japan.
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Shimizu
keywords: Endoscopic biliary drainage; Jaundice; Malignant biliary obstruction