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2000
Volume 4, Issue 1
  • ISSN: 2666-2906
  • E-ISSN: 2666-2914

Abstract

Background/Introduction

Endoscopic Retrograde Cholangiopancreatography (ERCP) is the gold standard for managing biliary drainage in patients with Common Bile Duct (CBD) obstruction, boasting a success rate exceeding 95%. However, its efficacy is limited in cases involving tumor invasion of the duodenum or major papilla, as well as post-surgical conditions.

Objectives

This study evaluates the outcomes of Endoscopic Ultrasound (EUS)-guided choledochoduodenostomy as an alternative for patients with unsuccessful ERCP due to malignant mid and lower-end biliary obstruction at our center.

Methods

A single-center prospective observational study was conducted from September 2018 to March 2020, compiling data from patients with confirmed malignancy and mid to lower-end CBD block undergoing choledochoduodenostomy. Exclusion criteria included pregnancy, heart, renal, and hepatic failure, and bleeding disorders. The study assessed technical success (successful stent placement) and clinical success (≥50% reduction in serum total bilirubin at day 14). Procedure and follow-up complications were also documented.

Results and Discussion

EUS-guided choledochoduodenostomy was performed on 12 patients with varying causes of biliary obstruction: seven with pancreatic cancer, one with periampullary carcinoma and lower CBD strictures, two with gallbladder carcinoma and mid-CBD block due to metastatic lymph nodes, and two with ampullary carcinoma. The mean bilirubin was 21.8 mg/dL (±3.4 mg/dL). The study showed a 100% technical success rate and a 91.67% clinical success rate. Minor procedure-related complications were observed, including one case of local bleeding and one case of stent blockage. Additionally, two patients experienced stent migration during follow-up. The 12-month follow-up revealed a 65% survival rate, with four patients succumbing to their underlying malignancy or other causes.

Conclusion

EUS-guided choledochoduodenostomy is a safe and effective alternative for biliary drainage in patients with mid and lower-end malignant CBD block after failed ERCP.

© 2025 Bentham Science Publishers
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2025-03-05
2025-09-26

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References

  1. GiovanniniM. MoutardierV. PesentiC. BoriesE. LelongB. DelperoJ. Endoscopic ultrasound-guided bilioduodenal anastomosis: A new technique for biliary drainage.Endoscopy2001331089890010.1055/s‑2001‑17324 11571690
     [Google Scholar]
  2. ParkD.H. KooJ.E. OhJ. LeeY.H. MoonS.H. LeeS.S. SeoD.W. LeeS.K. KimM.H. EUS-guided biliary drainage with one-step placement of a fully covered metal stent for malignant biliary obstruction: A prospective feasibility study.Am. J. Gastroenterol.200910492168217410.1038/ajg.2009.254 19513026
     [Google Scholar]
  3. HaraK. YamaoK. NiwaY. SawakiA. MizunoN. HijiokaS. TajikaM. KawaiH. KondoS. KobayashiY. MatumotoK. BhatiaV. ShimizuY. ItoA. HirookaY. GotoH. Prospective clinical study of EUS-guided choledochoduodenostomy for malignant lower biliary tract obstruction.Am. J. Gastroenterol.201110671239124510.1038/ajg.2011.84 21448148
     [Google Scholar]
  4. ParkD.H. JangJ.W. LeeS.S. SeoD.W. LeeS.K. KimM.H. EUS-guided biliary drainage with transluminal stenting after failed ERCP: Predictors of adverse events and long-term results.Gastrointest. Endosc.20117461276128410.1016/j.gie.2011.07.054 21963067
     [Google Scholar]
  5. SinglaV. PrajapatiR. AnikhindiS.A. KumarM. KumarA. SharmaP. BansalN. AroraA. Endoscopic ultrasound-guided choledochoduodenostomy for biliary drainage in patients with lower end common bile duct block: A single-center experience.Journal of Digestive Endoscopy20189100600910.4103/jde.JDE_49_17
     [Google Scholar]
  6. PaikW.H. LeeT.H. ParkD.H. ChoiJ.H. KimS.O. JangS. KimD.U. ShimJ.H. SongT.J. LeeS.S. SeoD.W. LeeS.K. KimM.H. EUS-guided biliary drainage versus ERCP for the primary palliation of malignant biliary obstruction: A multicenter randomized clinical trial.Am. J. Gastroenterol.2018113798799710.1038/s41395‑018‑0122‑8 29961772
     [Google Scholar]
  7. UemuraR.S. KhanM.A. OtochJ.P. KahalehM. MonteroE.F. ArtifonE.L.A. EUS-guided choledochoduodenostomy versus hepaticogastrostomy: A systematic review and meta-analysis.J. Clin. Gastroenterol.201852212313010.1097/MCG.0000000000000948 29095426
     [Google Scholar]
  8. HanadaK. IiboshiT. IshiiY. Endoscopic ultrasound-guided choledochoduodenostomy for palliative biliary drainage in cases with inoperable pancreas head carcinoma.Dig. Endosc.200921s1Suppl. 1S75S7810.1111/j.1443‑1661.2009.00855.x 19691742
     [Google Scholar]
  9. AmatoA. SinagraE. CelsaC. EneaM. BudaA. VieceliF. ScaramellaL. BelletruttiP. FugazzaA. CammàC. RadaelliF. RepiciA. AnderloniA. Efficacy of lumen-apposing metal stents or self-expandable metal stents for endoscopic ultrasound-guided choledochoduodenostomy: A systematic review and meta-analysis.Endoscopy202153101037104710.1055/a‑1324‑7919 33246343
     [Google Scholar]
  10. ParkD.H. SongT.J. EumJ. MoonS.H. LeeS.S. SeoD.W. LeeS.K. KimM.H. EUS-guided hepaticogastrostomy with a fully covered metal stent as the biliary diversion technique for an occluded biliary metal stent after a failed ERCP (with videos).Gastrointest. Endosc.201071241341910.1016/j.gie.2009.10.015 20152319
     [Google Scholar]
  11. GiovanniniM. DottiM. BoriesE. MoutardierV. PesentiC. DanisiC. DelperoJ. Hepaticogastrostomy by echo-endoscopy as a palliative treatment in a patient with metastatic biliary obstruction.Endoscopy200335121076107810.1055/s‑2003‑44596 14648424
     [Google Scholar]
  12. BoulayB.R. LoS.K. Endoscopic ultrasound-guided biliary drainage.Gastrointest. Endosc. Clin. N. Am.201828217118510.1016/j.giec.2017.11.005 29519330
     [Google Scholar]
  13. KhashabM.A. MessallamA.A. PenasI. NakaiY. ModayilR.J. De la SernaC. HaraK. El ZeinM. StavropoulosS.N. Perez-MirandaM. KumbhariV. NgamruengphongS. DhirV.K. ParkD.H. International multicenter comparative trial of transluminal EUS-guided biliary drainage via hepatogastrostomy vs. choledochoduodenostomy approaches.Endosc. Int. Open201642E175E18110.1055/s‑0041‑109083 26878045
     [Google Scholar]
  14. von ElmE. AltmanD.G. EggerM. PocockS.J. GøtzscheP.C. VandenbrouckeJ.P. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: Guidelines for reporting observational studies.Lancet200737095961453145710.1016/S0140‑6736(07)61602‑X 18064739
     [Google Scholar]
  15. ChoJ.H. ParkS.W. KimE.J. ParkC.H. ParkD.H. LeeK.J. LeeS.S. Long-term outcomes and predictors of adverse events of EUS-guided hepatico-gastrostomy for malignant biliary obstruction: Multicenter, retrospective study.Surg. Endosc.202236128950895810.1007/s00464‑022‑09346‑z 35680668
     [Google Scholar]
  16. ParkC.H. ParkS.W. NamE. JungJ.H. JoJ.H. Comparative efficacy of stents in endoscopic ultrasonography‐guided peripancreatic fluid collection drainage: A systematic review and network meta‐analysis.J. Gastroenterol. Hepatol.202035694195210.1111/jgh.14960 31881097
     [Google Scholar]
  17. MinagaK. OguraT. ShiomiH. ImaiH. HokiN. TakenakaM. NishikioriH. YamashitaY. HisaT. KatoH. KamadaH. OkudaA. SagamiR. HashimotoH. HiguchiK. ChibaY. KudoM. KitanoM. Comparison of the efficacy and safety of endoscopic ultrasound‐guided choledochoduodenostomy and hepaticogastrostomy for malignant distal biliary obstruction: Multicenter, randomized, clinical trial.Dig. Endosc.201931557558210.1111/den.13406 30908711
     [Google Scholar]
  18. BoriesE. De CassanC. PesentiC. CaillolF. GodatS. RatoneJ. DelperoJ. EwaldJ. GiovanniniM. Use of partially covered and uncovered metallic prosthesis for endoscopic ultrasound-guided hepaticogastrostomy: Results of a retrospective monocentric study.Endosc. Ultrasound20176532933510.4103/2303‑9027.209869 28685745
     [Google Scholar]
  19. KannoY. KoshitaS. OgawaT. MasuK. KusunoseH. SakaiT. MurabayashiT. HasegawaS. KozakaiF. YonamineK. KawakamiY. FujiiY. HoraguchiJ. NodaY. ItoK. EUS-guided biliary drainage for unresectable malignant biliary obstruction: 10-year experience of 99 cases at a single center.J. Gastrointest. Cancer201950346947710.1007/s12029‑018‑0096‑1 29656352
     [Google Scholar]
  20. OguraT. ChibaY. MasudaD. KitanoM. SanoT. SaoriO. YamamotoK. ImaokaH. ImotoA. TakeuchiT. FukunishiS. HiguchiK. Comparison of the clinical impact of endoscopic ultrasound-guided choledochoduodenostomy and hepaticogastrostomy for bile duct obstruction with duodenal obstruction.Endoscopy2016482156163 26382307
     [Google Scholar]
  21. da SilvaR.R.R. Facanali JuniorM.R. BrunaldiV.O. OtochJ.P. RochaA.C.A. ArtifonE.L.A. EUS-guided choledochoduodenostomy for malignant biliary obstruction: A multicenter comparative study between plastic and metallic stents.Endosc. Ultrasound202312112012710.4103/EUS‑D‑21‑00221 36861511
     [Google Scholar]
  22. KawakuboK. IsayamaH. KatoH. ItoiT. KawakamiH. HanadaK. IshiwatariH. YasudaI. KawamotoH. ItokawaF. KuwataniM. IiboshiT. HayashiT. DoiS. NakaiY. Multicenter retrospective study of endoscopic ultrasound-guided biliary drainage for malignant biliary obstruction in Japan.J. Hepatobiliary Pancreat. Sci.201421532833410.1002/jhbp.27 24026963
     [Google Scholar]
  23. JagielskiM. ZielińskiM. PiątkowskiJ. JackowskiM. Outcomes and limitations of endoscopic ultrasound-guided hepaticogastrostomy in malignant biliary obstruction.BMC Gastroenterol.202121120210.1186/s12876‑021‑01798‑2 33952187
     [Google Scholar]
  24. ArtifonE.L.A. MarsonF.P. GaidhaneM. KahalehM. OtochJ.P. Hepaticogastrostomy or choledochoduodenostomy for distal malignant biliary obstruction after failed ERCP: Is there any difference?Gastrointest. Endosc.201581495095910.1016/j.gie.2014.09.047 25500330
     [Google Scholar]
  25. KhanM.A. AkbarA. BaronT.H. KhanS. KocakM. AlastalY. HammadT. LeeW.M. SofiA. ArtifonE.L.A. NawrasA. IsmailM.K. Endoscopic ultrasound-guided biliary drainage: A systematic review and meta-analysis.Dig. Dis. Sci.201661368470310.1007/s10620‑015‑3933‑0 26518417
     [Google Scholar]
  26. WangK. ZhuJ. XingL. WangY. JinZ. LiZ. Assessment of efficacy and safety of EUS-guided biliary drainage: A systematic review.Gastrointest. Endosc.20168361218122710.1016/j.gie.2015.10.033 26542374
     [Google Scholar]
  27. MooleH. BechtoldM.L. ForcioneD. PuliS.R. A meta-analysis and systematic review.Medicine (Baltimore)2017963e515410.1097/MD.0000000000005154 28099327
     [Google Scholar]
  28. DhirV. ArtifonE.L.A. GuptaK. VilaJ.J. MaselliR. FrazaoM. MaydeoA. Multicenter study on endoscopic ultrasound‐guided expandable biliary metal stent placement: Choice of access route, direction of stent insertion, and drainage route.Dig. Endosc.201426343043510.1111/den.12153 23941261
     [Google Scholar]
  29. HedjoudjeA. SportesA. GrabarS. ZhangA. KochS. VuittonL. PratF. Outcomes of endoscopic ultrasound‐guided biliary drainage: A systematic review and meta‐analysis.United European Gastroenterol. J.201971606810.1177/2050640618808147 30788117
     [Google Scholar]
  30. ChanS.M. TeohA.Y.B. Endoscopic ultrasound-guided biliary drainage: A review.Curr. Treat. Options Gastroenterol.201513217118410.1007/s11938‑015‑0047‑x 25783788
     [Google Scholar]
  31. FacciorussoA. MangiavillanoB. PaduanoD. BindaC. CrinòS.F. GkolfakisP. RamaiD. FugazzaA. TarantinoI. LisottiA. FusaroliP. FabbriC. AnderloniA. Methods for drainage of distal malignant biliary obstruction after ERCP failure: A systematic review and network meta-analysis.Cancers (Basel)20221413329110.3390/cancers14133291 35805062
     [Google Scholar]
  32. van der MerweS.W. van WanrooijR.L.J. BronswijkM. EverettS. LakhtakiaS. RimbasM. HuclT. KundaR. BadaouiA. LawR. ArcidiaconoP.G. LarghiA. GiovanniniM. KhashabM.A. BinmoellerK.F. BarthetM. Perez-MirandaM. van HooftJ.E. Therapeutic endoscopic ultrasound: European Society of Gastrointestinal Endoscopy (ESGE) guideline.Endoscopy202254218520510.1055/a‑1717‑1391 34937098
     [Google Scholar]
  33. DhirV. ItoiT. KhashabM.A. ParkD.H. TeohA.Y.B. AttamR. MessallamA. VaradarajuluS. MaydeoA. Multicenter comparative evaluation of endoscopic placement of expandable metal stents for malignant distal common bile duct obstruction by ERCP or EUS-guided approach.Gastrointest. Endosc.201581491392310.1016/j.gie.2014.09.054 25484326
     [Google Scholar]
/content/journals/ijghd/10.2174/0126662906337669250214050953
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Endoscopic Ultrasound-Guided Choledochoduodenostomy: Evaluating Safety and Efficacy for Biliary Drainage in Common Bile Duct Obstruction
Int J Gastroenterol Hepatol Dis 4, E26662906337669 (2025); https://doi.org/10.2174/0126662906337669250214050953
/content/journals/ijghd/10.2174/0126662906337669250214050953
/content/journals/ijghd/10.2174/0126662906337669250214050953
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  • Article Type:     Research Article
Keyword(s): bile duct obstruction; biliary drainage; choledochoduodenostomy; endoscopic retrograde cholangiopancreatography; endoscopic ultrasound; Endoscopic ultrasound

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