Publicação
Endoscopic Ultrasound-Guided Choledochoduodenostomy as Palliative Treatment: A Challenging Case Report
| Resumo: | We report the case of an 88-year-old female with obstructive jaundice due to a periampullary tumor. The patient developed acute cholangitis and consequent clinical deterioration, so it was decided to perform palliative biliary drainage. Due to duodenal tumor invasion, it was not possible to perform endoscopic retrograde cholangiopancreatography. A different approach was attempted and it was decided to carry out an endoscopic ultrasound-guided choledochoduodenostomy. This procedure was performed with a linear echoendoscope, and using a duodenal bulbar approach, a fistula was created between the bulb and the common bile duct. A self-expandable fully covered metal biliary stent was placed in the common bile duct under endoscopic and fluoroscopic guidance, allowing biliary drainage. The patient presented clinical improvement. However, 3 weeks after being discharged, she was readmitted to our department with hematemesis associated with the migration of the biliary stent to the duodenal bulb. Endoscopic hemostasis was performed but the patient had multiple bleeding relapses that were controlled through arterial embolization. Despite the migration of the biliary stent, the fistula between the duodenum and the common bile duct remained patent, allowing a successful palliation of the obstructive jaundice. Therefore, despite the occurred complication, we admitted a technical and clinical success of the endoscopic ultrasound-guided choledochoduodenostomy. This is an emerging technique and a valuable alternative for palliative biliary drainage in cases of malignant distal obstruction. This clinical report supports this finding, reporting technical aspects of the procedure, associated complications and their management as well as the clinical outcomes. |
|---|---|
| Autores principais: | Ribeiro,Helena |
| Outros Autores: | Azevedo,Richard; Caldeira,Ana; Sousa,Rui; Pereira,Eduardo; Banhudo,António |
| Assunto: | Endoscopic ultrasound-guided choledochoduodenostomy Periampullary tumors Obstructive jaundice Palliative biliary drainage |
| Ano: | 2018 |
| País: | Portugal |
| Tipo de documento: | relatório |
| Tipo de acesso: | acesso aberto |
| Instituição associada: | Fundação para a Ciência e Tecnologia |
| Idioma: | inglês |
| Origem: | SciELO Portugal |
| _version_ | 1868441987790667776 |
|---|---|
| author | Ribeiro,Helena |
| author2 | Azevedo,Richard Caldeira,Ana Sousa,Rui Pereira,Eduardo Banhudo,António |
| author2_role | author author author author author |
| author_facet | Ribeiro,Helena Azevedo,Richard Caldeira,Ana Sousa,Rui Pereira,Eduardo Banhudo,António |
| author_role | author |
| country_str | PT |
| creators_json_txt | [{\"Person.name\":\"Ribeiro,Helena\"},{\"Person.name\":\"Azevedo,Richard\"},{\"Person.name\":\"Caldeira,Ana\"},{\"Person.name\":\"Sousa,Rui\"},{\"Person.name\":\"Pereira,Eduardo\"},{\"Person.name\":\"Banhudo,António\"}] |
| datacite.creators.creator.creatorName.fl_str_mv | Ribeiro,Helena Azevedo,Richard Caldeira,Ana Sousa,Rui Pereira,Eduardo Banhudo,António |
| datacite.rights.fl_str_mv | http://purl.org/coar/access_right/c_abf2 |
| datacite.subjects.subject.fl_str_mv | Endoscopic ultrasound-guided choledochoduodenostomy Periampullary tumors Obstructive jaundice Palliative biliary drainage |
| datacite.titles.title.fl_str_mv | Endoscopic Ultrasound-Guided Choledochoduodenostomy as Palliative Treatment: A Challenging Case Report |
| dc.creator.none.fl_str_mv | Ribeiro,Helena Azevedo,Richard Caldeira,Ana Sousa,Rui Pereira,Eduardo Banhudo,António |
| dc.format.none.fl_str_mv | text/html |
| dc.identifier.none.fl_str_mv | http://scielo.pt/scielo.php?script=sci_arttext&pid=S2341-45452018000300009 |
| dc.language.none.fl_str_mv | eng |
| dc.publisher.none.fl_str_mv | Sociedade Portuguesa de Gastrenterologia |
| dc.rights.none.fl_str_mv | http://purl.org/coar/access_right/c_abf2 |
| dc.source.none.fl_str_mv | GE-Portuguese Journal of Gastroenterology v.25 n.3 2018 |
| dc.subject.none.fl_str_mv | Endoscopic ultrasound-guided choledochoduodenostomy Periampullary tumors Obstructive jaundice Palliative biliary drainage |
| dc.title.fl_str_mv | Endoscopic Ultrasound-Guided Choledochoduodenostomy as Palliative Treatment: A Challenging Case Report |
| dc.type.none.fl_str_mv | http://purl.org/coar/resource_type/c_93fc |
| description | We report the case of an 88-year-old female with obstructive jaundice due to a periampullary tumor. The patient developed acute cholangitis and consequent clinical deterioration, so it was decided to perform palliative biliary drainage. Due to duodenal tumor invasion, it was not possible to perform endoscopic retrograde cholangiopancreatography. A different approach was attempted and it was decided to carry out an endoscopic ultrasound-guided choledochoduodenostomy. This procedure was performed with a linear echoendoscope, and using a duodenal bulbar approach, a fistula was created between the bulb and the common bile duct. A self-expandable fully covered metal biliary stent was placed in the common bile duct under endoscopic and fluoroscopic guidance, allowing biliary drainage. The patient presented clinical improvement. However, 3 weeks after being discharged, she was readmitted to our department with hematemesis associated with the migration of the biliary stent to the duodenal bulb. Endoscopic hemostasis was performed but the patient had multiple bleeding relapses that were controlled through arterial embolization. Despite the migration of the biliary stent, the fistula between the duodenum and the common bile duct remained patent, allowing a successful palliation of the obstructive jaundice. Therefore, despite the occurred complication, we admitted a technical and clinical success of the endoscopic ultrasound-guided choledochoduodenostomy. This is an emerging technique and a valuable alternative for palliative biliary drainage in cases of malignant distal obstruction. This clinical report supports this finding, reporting technical aspects of the procedure, associated complications and their management as well as the clinical outcomes. |
| dirty | 0 |
| eu_rights_str_mv | openAccess |
| format | report |
| id | scielopt_67b6d166360690ab180c0fffcabc02df |
| identifier.url.fl_str_mv | http://scielo.pt/scielo.php?script=sci_arttext&pid=S2341-45452018000300009 |
| instacron_str | SciELO |
| institution | Fundação para a Ciência e Tecnologia |
| instname_str | Fundação para a Ciência e Tecnologia |
| language | eng |
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| network_name_str | SciELO Portugal |
| oai_identifier_str | oai:scielo:S2341-45452018000300009 |
| organization_str_mv | urn:organizationAcronym:scielo |
| person_str_mv | Ribeiro,Helena Azevedo,Richard Caldeira,Ana Sousa,Rui Pereira,Eduardo Banhudo,António |
| publishDate | 2018 |
| publisher.none.fl_str_mv | Sociedade Portuguesa de Gastrenterologia |
| reponame_str | SciELO Portugal |
| repository_id_str | urn:repositoryAcronym:scielopt |
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| spelling | Endoscopic Ultrasound-Guided Choledochoduodenostomy as Palliative Treatment: A Challenging Case ReportRibeiro,HelenaAzevedo,RichardCaldeira,AnaSousa,RuiPereira,EduardoBanhudo,AntónioEndoscopic ultrasound-guided choledochoduodenostomyPeriampullary tumorsObstructive jaundicePalliative biliary drainageopen accesshttp://purl.org/coar/access_right/c_abf2http://scielo.pt/scielo.php?script=sci_arttext&pid=S2341-45452018000300009URLhttp://scielo.pt/scielo.php?script=sci_arttext&pid=S2341-45452018000300009URLHasVersion2018-06-01We report the case of an 88-year-old female with obstructive jaundice due to a periampullary tumor. The patient developed acute cholangitis and consequent clinical deterioration, so it was decided to perform palliative biliary drainage. Due to duodenal tumor invasion, it was not possible to perform endoscopic retrograde cholangiopancreatography. A different approach was attempted and it was decided to carry out an endoscopic ultrasound-guided choledochoduodenostomy. This procedure was performed with a linear echoendoscope, and using a duodenal bulbar approach, a fistula was created between the bulb and the common bile duct. A self-expandable fully covered metal biliary stent was placed in the common bile duct under endoscopic and fluoroscopic guidance, allowing biliary drainage. The patient presented clinical improvement. However, 3 weeks after being discharged, she was readmitted to our department with hematemesis associated with the migration of the biliary stent to the duodenal bulb. Endoscopic hemostasis was performed but the patient had multiple bleeding relapses that were controlled through arterial embolization. Despite the migration of the biliary stent, the fistula between the duodenum and the common bile duct remained patent, allowing a successful palliation of the obstructive jaundice. Therefore, despite the occurred complication, we admitted a technical and clinical success of the endoscopic ultrasound-guided choledochoduodenostomy. This is an emerging technique and a valuable alternative for palliative biliary drainage in cases of malignant distal obstruction. This clinical report supports this finding, reporting technical aspects of the procedure, associated complications and their management as well as the clinical outcomes.Sociedade Portuguesa de GastrenterologiaGE-Portuguese Journal of Gastroenterology v.25 n.3 2018text/htmlengreporthttp://purl.org/coar/resource_type/c_93fcother research product |
| spellingShingle | Endoscopic Ultrasound-Guided Choledochoduodenostomy as Palliative Treatment: A Challenging Case Report Ribeiro,Helena Endoscopic ultrasound-guided choledochoduodenostomy Periampullary tumors Obstructive jaundice Palliative biliary drainage |
| status | SINGLETON |
| subject.fl_str_mv | Endoscopic ultrasound-guided choledochoduodenostomy Periampullary tumors Obstructive jaundice Palliative biliary drainage |
| title | Endoscopic Ultrasound-Guided Choledochoduodenostomy as Palliative Treatment: A Challenging Case Report |
| title_full | Endoscopic Ultrasound-Guided Choledochoduodenostomy as Palliative Treatment: A Challenging Case Report |
| title_fullStr | Endoscopic Ultrasound-Guided Choledochoduodenostomy as Palliative Treatment: A Challenging Case Report |
| title_full_unstemmed | Endoscopic Ultrasound-Guided Choledochoduodenostomy as Palliative Treatment: A Challenging Case Report |
| title_short | Endoscopic Ultrasound-Guided Choledochoduodenostomy as Palliative Treatment: A Challenging Case Report |
| title_sort | Endoscopic Ultrasound-Guided Choledochoduodenostomy as Palliative Treatment: A Challenging Case Report |
| topic | Endoscopic ultrasound-guided choledochoduodenostomy Periampullary tumors Obstructive jaundice Palliative biliary drainage |
| topic_facet | Endoscopic ultrasound-guided choledochoduodenostomy Periampullary tumors Obstructive jaundice Palliative biliary drainage |
| url | http://scielo.pt/scielo.php?script=sci_arttext&pid=S2341-45452018000300009 |
| visible | 1 |