Clin Endosc.  2024 Jan;57(1):122-127. 10.5946/ce.2022.149.

Refractory benign biliary stricture due to chronic pancreatitis in two patients treated using endoscopic ultrasound-guided choledochoduodenostomy fistula creation: case reports

• Ishikawa S
• Okuno N
• Hara K
• Mizuno N
• Haba S
• Kuwahara T
• Kuraishi Y
• Yanaidani T

• KMID: 2551201
• DOI: http://doi.org/10.5946/ce.2022.149

Abstract

Benign biliary stricture (BBS) is a complication of chronic pancreatitis (CP). Despite endoscopic biliary stenting, some patients do not respond to treatment, and they experience recurrent cholangitis. We report two cases of CP with refractory BBS treated using endoscopic ultrasound-guided choledochoduodenostomy (EUS-CDS) fistula creation. A 50-year-old woman and a 60-year-old man both presented with obstructive jaundice secondary to BBS due to alcoholic CP. They underwent repeated placement of a fully covered self-expandable metal stent for biliary strictures. However, the strictures persisted, causing repeated episodes of cholangitis. Therefore, an EUS-CDS was performed. The stents were eventually removed and the patients became stent-free. These fistulas have remained patent without cholangitis for more than 2.5 years. Fistula creation using EUS-CDS is an effective treatment option for BBS.

Keyword

Benign biliary stricture; Chronic pancreatitis; Endoscopic ultrasound-guided choledochoduodenostomy; Fully covered self-expandable metal stent

Figure

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  Fig. 1. Endoscopic ultrasound-guided choledochoduodenostomy (EUS-CDS) procedure. (A) Fluoroscopic image of a fully covered self-expandable metal stent being placed during EUS-CDS. (B) Endoscopic image of an inserted fully covered self-expandable metal stent using EUS-CDS.

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  Fig. 2. Endoscopic findings of the fistula. (A) At the time of stent removal at 12 months after endoscopic ultrasound-guided choledochoduodenostomy. (B) 2.5 years after the stent removal. (C) 3.5 years after the stent removal.

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  Fig. 3. Endoscopic ultrasound-guided choledochoduodenostomy (EUS-CDS) procedure. (A) Fluoroscopic image of a fully covered self-expandable metal stent being placed during EUS-CDS. (B) Endoscopic image of an inserted fully covered self-expandable metal stent using EUS-CDS.

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  Fig. 4. Findings at the time of fistula dilation at six months after endoscopic ultrasound-guided choledochoduodenostomy. (A) At the time of stent dislocation. (B) Fistula dilation with a balloon up to 10-mm diameter.

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  Fig. 5. Fistula treatment at 32 months after endoscopic ultrasound-guided choledochoduodenostomy (EUS-CDS) and subsequent endoscopic findings. (A) Fistula before balloon dilation. (B) Fistula dilation with a balloon up to 13.5 mm diameter. (C) Fistula after the balloon dilation. (D) Clips placed around the fistula. (E) Patent fistula at two years after the balloon dilation and five years from the EUS-CDS.

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