PTCD-guided ERCP for malignant biliary obstruction caused by a pancreatic lesion clinically suspicious for colorectal cancer metastasis: a case report

Background: Malignant biliary obstruction (MBO) frequently necessitates palliative drainage. While conventional endoscopic retrograde cholangiopancreatography (ERCP) is the preferred initial intervention, cannulation can fail in patients with severe malignant strictures, tumor infiltration, or altered anatomy. Although percutaneous transhepatic cholangiographic drainage (PTCD) serves as a reliable rescue alternative, prolonged external drainage significantly impairs the patient’s quality of life. The percutaneous-endoscopic rendezvous technique (PTCD-guided ERCP) offers an effective hybrid solution to achieve internal drainage. However, its application in MBO secondary to metastatic disease remains infrequently described. Here, we report a relatively rare case in which this combined approach was successfully used to place a biliary stent in a patient with obstructive jaundice caused by a pancreatic lesion clinically suspicious for a colorectal cancer metastasis. Case summary: A 78-year-old man with a history of rectal cancer presented with severe obstructive jaundice. Imaging revealed a pancreatic mass clinically suspicious for colorectal cancer metastasis in the head/periampullary region, compressing the distal bile duct. Conventional ERCP for biliary drainage failed due to unsuccessful cannulation of the major duodenal papilla. Consequently, we employed a PTCD-guided percutaneous-endoscopic rendezvous technique. A guidewire was passed antegrade via the PTCD tract, facilitating the successful endoscopic placement of an internal biliary stent. Postoperatively, the patient’s obstructive jaundice completely resolved without severe complications. Result: Serum bilirubin levels decreased significantly within 2 weeks post-procedure, with no early complications, such as bleeding, pancreatitis, or stent occlusion. Clinical resolution of jaundice and stent patency were maintained for over 2 months. Unfortunately, the patient declined further antineoplastic therapy and succumbed to disease progression shortly after discharge.