Endoscopic Ultrasound-Guided Choledochoduodenostomy: Evaluating Safety and Efficacy for Biliary Drainage in Common Bile Duct Obstruction

Background/Introduction: Endoscopic Retrograde Cholangiopancreatography (ERCP) is the gold standard for managing biliary drainage in patients with Common Bile Duct (CBD) obstruction, boasting a success rate exceeding 95%. However, its efficacy is limited in cases involving tumor invasion of the duodenum or major papilla, as well as post-surgical conditions. Objectives: This study evaluates the outcomes of Endoscopic Ultrasound (EUS)-guided choledochoduodenostomy as an alternative for patients with unsuccessful ERCP due to malignant mid and lower-end biliary obstruction at our center. Methods: A single-center prospective observational study was conducted from September 2018 to March 2020, compiling data from patients with confirmed malignancy and mid to lower-end CBD block undergoing choledochoduodenostomy. Exclusion criteria included pregnancy, heart, renal, and hepatic failure, and bleeding disorders. The study assessed technical success (successful stent placement) and clinical success (≥50% reduction in serum total bilirubin at day 14). Procedure and follow-up complications were also documented. Results and Discussion: EUS-guided choledochoduodenostomy was performed on 12 patients with varying causes of biliary obstruction: seven with pancreatic cancer, one with periampullary carcinoma and lower CBD strictures, two with gallbladder carcinoma and mid-CBD block due to metastatic lymph nodes, and two with ampullary carcinoma. The mean bilirubin was 21.8 mg/dL (±3.4 mg/dL). The study showed a 100% technical success rate and a 91.67% clinical success rate. Minor procedure-related complications were observed, including one case of local bleeding and one case of stent blockage. Additionally, two patients experienced stent migration during follow-up. The 12- month follow-up revealed a 65% survival rate, with four patients succumbing to their underlying malignancy or other causes. Conclusion: EUS-guided choledochoduodenostomy is a safe and effective alternative for biliary drainage in patients with mid and lower-end malignant CBD block after failed ERCP.