Endoscopic Ultrasound-Guided Choledochoduodenostomy Using a Lumen-Apposing Metal Stent in Pancreatic Head Neoplasm-Associated Biliary Obstruction

Abstract

Endoscopic ultrasound (EUS)-guided transluminal drainage of obstructed bile duct with conventional metal and plastic stents has been in practice for several years, but this modality carries its own potential complications and obstacles. Nevertheless, the novel Hot AXIOS stent (Boston Scientific Corp., Marlborough, MA) has been shown to overcome some of those factors, which justifies its application in a variety of clinical indications, such as EUS-guided choledochoduodenostomy (EUS-CDS) for biliary drainage after failed endoscopic retrograde cholangiopancreatography. We present a case of EUS-CDS with an electrocautery enhanced lumen-apposing stent for biliary drainage.

A review of endoscopic ultrasound guided endoscopic retrograde cholangiopancreatography techniques in patients with surgically altered anatomy

“…When using the guidewire method usually the fistula needs to be dilated prior to stent placement. However, with new electrocauteryenhanced catheter deliver systems of lumen-apposing metal stents, it is possible to directly puncture the place a stent from the duodenal bulb into the EH bile duct in a single step (20). Preferred approaches include hepaticogastric (HG) or choledochoduodenal (CD).…”