SUCCESSFUL TREATMENT OF OBSTRUCTIVE JAUNDICE IN A CARCINOMA OF THE PAPILLA OF VATER BY ENDOSCOPIC ULTRASOUND-GUIDED CHOLEDOCHODUODENOSTOMY

A 78-year-old man who was admitted to Akita University Hospital complained of jaundice andabdominal discomfort. He was diagnosed with obstructive jaundice that was caused by the carcinomaof the papilla of Vater based on the esophagogastroduodenoscopy (EGD) with a biopsy andcomputed tomography (CT). His condition was inoperable due to hepatic and lung metastasis,and he rejected any chemotherapy. Therefore, a palliative therapy to decompress the biliaryobstruction for the improvement of jaundice and the prophylaxis of cholangitis wasrequired. Although endoscopic retrograde biliary drainage (ERBD) was first attempted todecompress the biliary obstruction, it failed because of the tumor invasion. Next, endoscopicultrasound-guided choledochoduodenostomy (EUS-CDS) was carried out successfully, and thejaundice improved with the decrease of the serum bilirubin values from 30.1 mg/dl to 6.1 mg/dl onthe day of his discharge. He left the hospital and maintained his quality of life.