EUS-Guided Choledochoduodenostomy for Malignant Distal Block: Personal Experience, Technical Features, Prevention of Complications

Purpose : To analyze the effectiveness of endoscopic choledochoduodenostomy for malignant distal block. Materials and methods : Treatment analysis was performed on 5 patients with mechanical jaundice caused by an unresectable malignant tumor of the pancreatic head. All patients underwent EUS-guided choledochoduodenostomy. Transpapillary drainage was impossible in 2 patients (40 %) due to tumor stenosis of the duodenum, in 2 (40 %) due to severe deformation and disrupted anatomy of the duodenal ulcer caused by tumor growth, in 1 patient (20 %) due to the formation of a false passage during transpapillary intervention caused by tumor destruction. The technical and clinical success of the operations performed and the presence of complications were assessed. Results : EUS-guided choledochoduodenostomy provided 100 % technical and clinical success in the treatment of mechanical jaundice in the study group of patients. The method allowed achieving a significant decrease in bilirubin already on the 3rd day (on average from 182.4 to 102.8 μmol/l). The technique demonstrated a shorter duration of the intervention (20.4±3.3 min for EUS-CDA versus 54.7±9.6 min for transpapillary attempts). With observance of the technical aspects of the operation, no complications were recorded, but the method requires high-tech equipment and the experience of an endosonographist. Conclusion : EUS-guided choledochoduodenostomy is an effective method of biliary decompression. Prevention of possible complications, taking into account the capabilities of endosonography, design features of the equipment and endoscopic instruments used, allows avoiding undesirable consequences. Positive results of using this technique justify the need for its further implementation in the practice of specialized centers.