Endoscopic Ultrasound Guided Choledocho -Duodenostomy
A 55 year old lady presented with metastatic pancreatic head malignancy and obstructive jaundice. Duodenal infiltration was noted causing luminal narrowing (duodenoscope could not be negotiated).
Diagnosis And Treatment
EUS guided puncture of CBD was done from the first part of duodenum. After cholangiogram, the tract was dilated with cystotomes sequentially till 10 F and a 60x10mm fully covered biliary stent was deployed connecting D1 and CBD. A 7F 7cm double pigtail plastic biliary stent was deployed within the metal stent to prevent its displacement. There were no periprocedural complications. She had normalization of bilirubin in one week and she underwent chemotherapy.
EUS guided puncture of CBD and cholangiogram
choledochoduodenostomywith a FCSSEMS(fully covered self expanding metal stent)
Plastic stent with in theFCSEMS in D1