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 and abdominal discomfort. He was diagnosed with obstructive jaundice that was caused by the carcinoma of the papilla of Vater based on the esophagogastroduodenoscopy (EGD) with a biopsy and computed tomography (CT). His condition was inoperable due to hepatic and lung metastasis, and he rejected any chemotherapy. Therefore, a palliative therapy to decompress the biliary obstruction for the improvement of jaundice and the prophylaxis of cholangitis was required. Although endoscopic retrograde biliary drainage (ERBD) was first attempted to decompress the biliary obstruction, it failed because of the tumor invasion. Next, endoscopic ultrasound-guided choledochoduodenostomy (EUS-CDS) was carried out successfully, and the jaundice improved with the decrease of the serum bilirubin values from 30.1 mg/dl to 6.1 mg/dl on the day of his discharge. He left the hospital and maintained his quality of life.