Percutaneous choledocho-duodenal shunt for malignant biliary obstruction

We developed a new method: percutaneous choledocho-duodenal shunt (PCDS) for complete biliary obstruction patient. At fi rst, percutaneous transhepatic cholangio drainage (PTCD) is performed as usual manner with local anesthesia. After the patient is recovered from bilirubinemia, percutaneous endoscopic gastrostomy (PEG) is performed with pull-through method under local anesthesia. Catheter of PEG is replaced to jejunal catheter after the gastrostomy is completed. These two catheters (catheter of PTCD and Jejunal catheter) are connected each other with extra-peritoneal shunt. The method is useful for the patient with complete biliary obstruction who cannot be performed biliary stenting.