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Case Reports
. 2024 Jan;57(1):122-127.
doi: 10.5946/ce.2022.149. Epub 2023 May 16.

Refractory benign biliary stricture due to chronic pancreatitis in two patients treated using endoscopic ultrasound-guided choledochoduodenostomy fistula creation: case reports

Sho Ishikawa  1 , Nozomi Okuno  1 , Kazuo Hara  1 , Nobumasa Mizuno  1 , Shin Haba  1 , Takamichi Kuwahara  1 , Yasuhiro Kuraishi  1 , Takafumi Yanaidani  1
Affiliations
Case Reports

Refractory benign biliary stricture due to chronic pancreatitis in two patients treated using endoscopic ultrasound-guided choledochoduodenostomy fistula creation: case reports

Sho Ishikawa et al. Clin Endosc. 2024 Jan.

Abstract

Benign biliary stricture (BBS) is a complication of chronic pancreatitis (CP). Despite endoscopic biliary stenting, some patients do not respond to treatment, and they experience recurrent cholangitis. We report two cases of CP with refractory BBS treated using endoscopic ultrasound-guided choledochoduodenostomy (EUS-CDS) fistula creation. A 50-year-old woman and a 60-year-old man both presented with obstructive jaundice secondary to BBS due to alcoholic CP. They underwent repeated placement of a fully covered self-expandable metal stent for biliary strictures. However, the strictures persisted, causing repeated episodes of cholangitis. Therefore, an EUS-CDS was performed. The stents were eventually removed and the patients became stent-free. These fistulas have remained patent without cholangitis for more than 2.5 years. Fistula creation using EUS-CDS is an effective treatment option for BBS.

Keywords: Benign biliary stricture; Biliary drainage; Chronic pancreatitis; Endoscopic ultrasound-guided choledochoduodenostomy.

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Conflict of interest statement

Conflicts of Interest

Dr. Nobumasa Mizuno reports having received grants and personal fees from Yakult Honsha, grants and personal fees from AstraZeneca, grants and personal fees from Novartis, grants and personal fees from MSD, grants from Ono Pharmaceutical, grants from Taiho Pharmaceutical, and grants from Eisai outside the submitted work. The other authors have no potential conflicts of interest.

Figures

Fig. 1.
Fig. 1.
Endoscopic ultrasound-guided choledochoduodenostomy (EUS-CDS) procedure. (A) Fluoroscopic image of a fully covered self-expandable metal stent being placed during EUS-CDS. (B) Endoscopic image of an inserted fully covered self-expandable metal stent using EUS-CDS.
Fig. 2.
Fig. 2.
Endoscopic findings of the fistula. (A) At the time of stent removal at 12 months after endoscopic ultrasound-guided choledochoduodenostomy. (B) 2.5 years after the stent removal. (C) 3.5 years after the stent removal.
Fig. 3.
Fig. 3.
Endoscopic ultrasound-guided choledochoduodenostomy (EUS-CDS) procedure. (A) Fluoroscopic image of a fully covered self-expandable metal stent being placed during EUS-CDS. (B) Endoscopic image of an inserted fully covered self-expandable metal stent using EUS-CDS.
Fig. 4.
Fig. 4.
Findings at the time of fistula dilation at six months after endoscopic ultrasound-guided choledochoduodenostomy. (A) At the time of stent dislocation. (B) Fistula dilation with a balloon up to 10-mm diameter.
Fig. 5.
Fig. 5.
Fistula treatment at 32 months after endoscopic ultrasound-guided choledochoduodenostomy (EUS-CDS) and subsequent endoscopic findings. (A) Fistula before balloon dilation. (B) Fistula dilation with a balloon up to 13.5 mm diameter. (C) Fistula after the balloon dilation. (D) Clips placed around the fistula. (E) Patent fistula at two years after the balloon dilation and five years from the EUS-CDS.
See this image and copyright information in PMC

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