Endoscopic ultrasound-guided choledochoduodenostomy using a lumen apposing metal stent for acute cholangitis

Abstract

We present the case of a 51-year-old woman with a history of uterine cancer who presented to the emergency room with a clinical picture of acute cholangitis. An abdominal ultrasound and a computed tomography scan were performed, revealing a gigantic lymphadenopathy mass compressing the common bile duct and the duodenum. After failure to perform an endoscopic retrograde cholangiopancreatography (ERCP) due to a modified anatomy, we performed an endoscopic ultrasound-guided choledochoduodenostomy (EUS-CDS) and placed a Hot AXIOS 10Fr/10 mm stent with efficient biliary drainage. In addition, we inserted a duodenal uncoated 120/22 mm expandable metallic stent. EUS-CDS presents a valid alternative in patients with failed ERCP and should be considered as an important option for rapid biliary decompression in patients with acute cholangitis.

Impact of biliary stenting in endoscopic ultrasound‐guided tissue acquisition among patients with pancreatic cancer

“…Cutting-edge techniques like biliarydigestive anastomosis using lumen apposing metal stents (LAMS) are elaborate endoscopic procedures which bring a brighter tinge to this dark corner of medicine. 9,10 As ERCP is more readily available and biliary decompression more urgent than obtaining tissue and staging the tumor, plastic or metallic stents insertion occurs frequently before EUS-FNA/FNB. By far, there are scarce studies which assess the yield and accuracy for cytologic diagnosis of pancreatic malignancy through EUS-FNA/FNB performed after biliary stents insertion.…”

“…Radiologic or sonographic guided endoscopic procedures like placing different dimension self‐expandable metal stents through digestive or biliary stenoses are globally replacing traditional surgery in most of the centers, offering patients a less traumatizing experience and hospitals a less expensive alternative. Cutting‐edge techniques like biliary‐digestive anastomosis using lumen apposing metal stents (LAMS) are elaborate endoscopic procedures which bring a brighter tinge to this dark corner of medicine 9,10 …”

Introductory Chapter: Endoscopy-Novel Techniques and Recent Advancements

“…Lumen-apposing metal stents are highlighting a fine line between the gastroenterology and surgical community [60] (Figure 5A, B). EUS-guided gallbladder drainage [61], EUS-choledochoduodenostomy [62], EUS-pancreaticogastrostomy [63], and the most recent EUS-gastrojejunostomy [64] represent some of the challenges that were introduced with focus on minimally invasive therapy.…”

EUS-Guided Transgastric Drainage of Intraabdominal Fluid Collections

“…These systems described above shorten the procedure duration by more than 80% and, in selected cases; they allow to perform the entire procedure exclusively with echoendoscopic control, avoiding the use of X-rays.The use of LAMS has emerged in the last years not only for the drainage of intraabdominal fluid collections but also for the palliation of malignant biliary-duodenal obstruction (18,19).…”