How about the feasibility of endoscopic ultrasonography-guided choledochoduodenostomy?

Endoscopic ultrasonography (EUS)-guided biliary drainage for treatment of patients who have obstructive jaundice in cases of failed endoscopic retrograde cholangiopancreatography (ERCP).

An article to be published on October 21, 2008 in the World Journal of Gastroenterology addresses the case. The research team led by Takao Itoi, from Tokyo Medical University Shinjuku-ku of Japan introduced the feasibility and outcome of EUS-guided choledochoduodenostomy in four patients who failed ERCP.

They performed the procedure in 2 papilla of Vater, including one resectable case, and 2 cases of cancer of the head of pancreas were applied for this procedure. Using a curved linear array echoendoscope, a 19 G needle or a needle knife was punctured transduodenally into the bile duct under EUS visualization. After using a biliary catheter for dilation, or papillary balloon dilator, a 7-Fr plastic stent was inserted through the choledochoduodenostomy site into the extrahepatic bile duct. In 3 of 4 (75%) cases, an indwelling plastic stent was placed, and in one case in which the stent could not be advanced into the bile duct, a naso-biliary drainage tube was placed instead.

In all cases, the obstructive jaundice rapidly improved after the procedure. Focal peritonitis and bleeding not requiring blood transfusion was seen in one cases. In this case, pancreatoduodenectomy was perfomed and the surgical findings revealed that severe adhesion around the choledochoduodenostomy site was recognized. Although further studies and development of devices are mandatory, EUS-guided choledochoduodenostomy may appear to be an effective alternative to ERCP in selected cases.

Reference: Itoi T, Itokawa F, Sofuni A, Kurahara T, Tsuchiya T, Ishii K, Tsuji S, Ikeuchi N, Moriyasu F. World J Gastroenterol 2008; 14(39): 6078-6082 http://www.wjgnet.com/1007-9327/14/6078.asp

Correspondence to: Takao Itoi, MD, Department of Gastroenterology and Hepatology, Tokyo Medical University Shinjuku-ku, Nishishinjuku 6-7-1, Tokyo 160-0023, Japan. itoi@tokyo-med.ac.jp Telephone: +81-3-33426111 Fax: +81-3-53816654

World Journal of Gastroenterology (WJG), a leading international journal in gastroenterology and hepatology, has established a reputation for publishing first class research on esophageal cancer, gastric cancer, liver cancer, viral hepatitis, colorectal cancer, and H pylori infection. It provides a forum for both clinicians and scientists. WJG has been indexed and abstracted in Current Contents/Clinical Medicine, Science Citation Index Expanded (also known as SciSearch) and Journal Citation Reports/Science Edition, Index Medicus, MEDLINE and PubMed, Chemical Abstracts, EMBASE/Excerpta Medica, Abstracts Journals, Nature Clinical Practice Gastroenterology and Hepatology, CAB Abstracts and Global Health. ISI JCR 2003-2000 IF: 3.318, 2.532, 1.445 and 0.993. WJG is a weekly journal published by WJG Press. The publication dates are the 7th, 14th, 21st, and 28th of every month. The WJG is supported by The National Natural Science Foundation of China, No. 30224801 and No. 30424812, and was founded with the title China National Journal of New Gastroenterology on October 1, 1995, and renamed WJG on January 25, 1998.

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