Gut Liver.  2012 Jul;6(3):399-402.

Simultaneous Duodenal Metal Stent Placement and EUS-Guided Choledochoduodenostomy for Unresectable Pancreatic Cancer

Affiliations
  • 1Department of Gastroenterology, The University of Tokyo Graduate School of Medicine, Tokyo, Japan. isayama-2im@h.u-tokyo.ac.jp

Abstract

Patients with pancreatic cancer frequently suffer from both biliary and duodenal obstruction. For such patients, both biliary and duodenal self-expandable metal stent placement is necessary to palliate their symptoms, but it was difficult to cross two metal stents. Recently, endoscopic ultrasonography-guided choledochoduodenostomy (EUS-CDS) was reported to be effective for patients with an inaccessible papilla. We report two cases of pancreatic cancer with both biliary and duodenal obstructions treated successfully with simultaneous duodenal metal stent placement and EUS-CDS. The first case was a 74-year-old man with pancreatic cancer. Duodenoscopy revealed that papilla had been invaded with tumor and duodenography showed severe stenosis in the horizontal portion. After a duodenal uncovered metal stent was placed across the duodenal stricture, EUS-CDS was performed. The second case was a 63-year-old man who previously had a covered metal stent placed for malignant biliary obstruction. After removing the previously placed metal stent, EUS-CDS was performed. Then, a duodenal covered metal stent was placed across the duodenal stenosis. Both patients could tolerate a regular diet and did not suffer from stent occlusion. EUS-CDS combined with duodenal metal stent placement may be an ideal treatment strategy in patients with pancreatic cancer with both duodenal and biliary malignant obstruction.

Keyword

Endoscopic ultrasonography-guided choledochoduodenostomy; Duodenal stent; Malignant biliary obstruction

MeSH Terms

Aged
Choledochostomy
Constriction, Pathologic
Diet
Duodenal Obstruction
Duodenoscopy
Humans
Middle Aged
Pancreatic Neoplasms
Stents
Duodenal Obstruction
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