P4496 - Endoscopic Ultrasound-Guided Choledochoduodenostomy (EUS-CDS) for Biliary Drainage in Malignant Common Bile Duct Obstruction With Failed ERCP: A Tertiary Care Hospital's Experience

Dhruvkumar Patel, MBBS¹, Maitri M. Patel, MBBS², Mukundkumar Patel, MD³, Lalitkumar Patel, MD⁴, Aditya Vyas, MD⁵, Hassaan A. Zia, MD^5
1LSU Health Science Center, Shreveport, LA; ²GCS Medical College and Research Centre, Ahmedabad, Gujarat, India; ³Ananya College of Medicine and Research, Ahmedabad, Gujarat, India; ⁴Narendra Modi Medical College, Ahmedabad, Gujarat, India; ⁵LSU Health, Shreveport, LA

Introduction: Endoscopic retrograde cholangiopancreatography (ERCP) is the established procedure for managing biliary drainage in patients with common bile duct obstruction, with a success rate exceeding 95%. However, its applicability diminishes in cases involving tumor invasion of the duodenum or major papilla, as well as in post-surgical scenarios. This study investigates the outcomes of endoscopic ultrasound (EUS)-guided choledochoduodenostomy as an alternative approach for patients with unsuccessful ERCP in cases of malignant mid and lower-end biliary obstruction with an unreachable papilla.

Methods: Conducted as a single-center prospective observational study, this research compiled data from patients undergoing choledochoduodenostomy confirmed malignancy with mid and lower-end common bile duct (CBD) block between September 2018 and March 2020. Exclusion criteria encompassed pregnancy, major organ failure, large volume ascites, compromised cardiovascular status, and bleeding disorders. The study assessed technical success, defined as successful stent placement in the biliary system, and successful clinical outcomes, defined as more than 50% reduction in bilirubin on the 14th day. Procedure and follow-up complications were also documented.

Results: EUS-guided choledochoduodenostomy was performed on 12 patients. The causes of biliary obstruction varied: seven cases were attributed to pancreatic cancer, one to lower CBD strictures with periampullary carcinoma, two to gallbladder carcinoma with mid-CBD block due to compression by metastatic lymph nodes, and two to ampullary carcinoma. The mean bilirubin value was 21.8 mg/dL (±3.4 mg/dL). The study demonstrated a 100% technical success rate and a 91.67% clinical success rate. No immediate procedure-related complications were observed, although two patients experienced stent migration during follow-up. Following an average follow-up period of 12 months (±2 months), the survival rate was recorded at 65%. Among the four patients who did not survive, three succumbed to the underlying malignancy, while one experienced a massive anterior wall myocardial infarction.

Discussion: EUS-guided choledochoduodenostomy is proving to be a safe and effective alternative for restoring biliary drainage in cases of mid and lower-end malignant CBD obstruction, particularly when the papilla is inaccessible and ERCP is not feasible.


Disclosures:


Dhruvkumar Patel, MBBS¹, Maitri M. Patel, MBBS², Mukundkumar Patel, MD³, Lalitkumar Patel, MD⁴, Aditya Vyas, MD⁵, Hassaan A. Zia, MD⁵. P4496 - Endoscopic Ultrasound-Guided Choledochoduodenostomy (EUS-CDS) for Biliary Drainage in Malignant Common Bile Duct Obstruction With Failed ERCP: A Tertiary Care Hospital's Experience, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.