{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T14:42:49Z","timestamp":1788878569458,"version":"build-2803163510"},"reference-count":28,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2023,2,13]],"date-time":"2023-02-13T00:00:00Z","timestamp":1676246400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Introduction. Pancreatic ductal adenocarcinoma (PDA) is associated with poor prognosis and 98% loss-of-life expectancy. 80% of patients with PDA are unfit for radical surgery. In those cases, emphasis is set on management of cancer-related symptoms, among which obstructive jaundice is most common. Endoscopic ultrasound-guided biliary drainage (EUS-BD) emerges as a valid alternative to the well-accepted methods for treatment of biliary obstruction. Patient Selection. Five consecutive patients with unresectable pancreatic malignancy, were subjected to EUS-BD, particularly EUS-guided choledochoduodenostomy (EUS-CDS). Ethics. Oral and written informed consent was obtained in all cases prior procedure. Technique. EUS-guided puncture of the common bile duct was performed, followed by advancement of a guidewire to the intrahepatic bile ducts. After dilation of the fistulous tract with a cystotome, a fully covered self-expandable metal stent was inserted below the hepatic confluence and extending at least 3 cm in the duodenum. Technical and clinical success was achieved in four patients without adverse events. In one patient procedure failed due to dislocation of the guidewire, with consequent biliary leakage requiring urgent surgery. Recovery was uneventful with no further clinical sequelae and there was no mortality associated with procedure. Discussion. Introduced in 2001, EUS-guided biliary drainage has become an accepted option for treatment of obstructive jaundice. According to recent guidelines published by European Society of Gastrointestinal Endoscopy (ESGE) in 2022, EUS-CDS is a preferred modality to percutaneous transhepatic biliary drainage (PTBD) and surgery in patients with failed ERCP, with comparable efficiency and better safety profile, which is supported by our experience with the procedure. Conclusions. Our case series suggests that EUS-CDS is an excellent option for palliative management of malignant distal biliary obstruction, emphasizes on the importance of adequate technique and experience for the technical success, and urges the need for future research on establishing the best choice for guidewire and dilation device.<\/jats:p>","DOI":"10.3390\/medicina59020351","type":"journal-article","created":{"date-parts":[[2023,2,13]],"date-time":"2023-02-13T03:28:46Z","timestamp":1676258926000},"page":"351","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Clinical Outcomes of EUS-Guided Choledochoduodenostomy for Biliary Drainage in Unresectable Pancreatic Cancer: A Case Series"],"prefix":"10.3390","volume":"59","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2943-1766","authenticated-orcid":false,"given":"Bozhidar","family":"Hristov","sequence":"first","affiliation":[{"name":"Second Department of Internal Diseases, Section \u201cGastroenterology\u201d, Medical Faculty, Medical University of Plovdiv, 6000 Plovdiv, Bulgaria"},{"name":"Gastroenterology Clinic, University Hospital \u201cKaspela\u201d, 4001 Plovdiv, Bulgaria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0736-2499","authenticated-orcid":false,"given":"Deyan","family":"Radev","sequence":"additional","affiliation":[{"name":"Second Department of Internal Diseases, Section \u201cGastroenterology\u201d, Medical Faculty, Medical University of Plovdiv, 6000 Plovdiv, Bulgaria"},{"name":"Gastroenterology Clinic, University Hospital \u201cKaspela\u201d, 4001 Plovdiv, Bulgaria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Petar","family":"Uchikov","sequence":"additional","affiliation":[{"name":"Department of Special Surgery, Faculty of Medicine, Medical University of Plovdiv, 6000 Plovdiv, Bulgaria"},{"name":"St. George University Hospital, 4000 Plovdiv, Bulgaria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5137-6903","authenticated-orcid":false,"given":"Gancho","family":"Kostov","sequence":"additional","affiliation":[{"name":"Department of Special Surgery, Faculty of Medicine, Medical University of Plovdiv, 6000 Plovdiv, Bulgaria"},{"name":"Department of Surgery, University Hospital \u201cKaspela\u201d, 4001 Plovdiv, Bulgaria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7029-8397","authenticated-orcid":false,"given":"Mladen","family":"Doykov","sequence":"additional","affiliation":[{"name":"Department of Urology and General Medicine, Medical Faculty, Medical University of Plovdiv, 6000 Plovdiv, Bulgaria"},{"name":"Clinic of Urology, University Hospital \u201cKaspela\u201d, 4001 Plovdiv, Bulgaria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Siyana","family":"Valova","sequence":"additional","affiliation":[{"name":"Second Department of Internal Diseases, Section \u201cNephrology\u201d, Medical Faculty, Medical University of Plovdiv, 6000 Plovdiv, Bulgaria"},{"name":"Clinic of Nephrology, University Hospital \u201cKaspela\u201d, 4001 Plovdiv, Bulgaria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eduard","family":"Tilkiyan","sequence":"additional","affiliation":[{"name":"Second Department of Internal Diseases, Section \u201cNephrology\u201d, Medical Faculty, Medical University of Plovdiv, 6000 Plovdiv, Bulgaria"},{"name":"Clinic of Nephrology, University Hospital \u201cKaspela\u201d, 4001 Plovdiv, Bulgaria"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,2,13]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"209","DOI":"10.3322\/caac.21660","article-title":"Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries","volume":"71","author":"Sung","year":"2021","journal-title":"CA Cancer J. 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