Endoscopic ultrasound-guided choledechoduodenostomy for palliative biliary drainage of obstructing pancreatic head mass

Endoscopic retrograde cholangiopancreatography (ERCP) is the standard procedure for biliary drainage (BD) in patients with benign or malignant biliary obstruction. [1] Therapeutic ERCP requires deep cannulation into the common bile duct (CBD), the success rate of deep cannulation is high, but still not perfect, even with the use of advanced cannulation techniques such as precut sphincterotomy.[2] In particular, periampullary diverticula,[3] tumor infiltration,[4] or altered surgical anatomy,[5] occasionally complicates biliary cannulation. Alternatives if deep biliary cannulation fails include percutaneous transhepatic BD (PTBD)[6] or surgical intervention.[7] However, both PTBD and surgical intervention are associated with considerable morbidity and occasional mortality.[7] We present the first case in Egypt with a malignant pancreatic head mass causing biliary obstruction that was successfully treated with endoscopic ultrasound (EUS)-guided choledochoduodenostomy (EUS-CDS).