Case Report
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Apr 28, 2016; 22(16): 4264-4269
Published online Apr 28, 2016. doi: 10.3748/wjg.v22.i16.4264
Urgent endoscopic ultrasound-guided choledochoduodenostomy for acute obstructive suppurative cholangitis-induced sepsis
Kosuke Minaga, Masayuki Kitano, Hajime Imai, Kentaro Yamao, Ken Kamata, Takeshi Miyata, Shunsuke Omoto, Kumpei Kadosaka, Tomoe Yoshikawa, Masatoshi Kudo
Kosuke Minaga, Masayuki Kitano, Hajime Imai, Kentaro Yamao, Ken Kamata, Takeshi Miyata, Shunsuke Omoto, Kumpei Kadosaka, Tomoe Yoshikawa, Masatoshi Kudo, Department of Gastroenterology and Hepatology, Kinki University Faculty of Medicine, Osaka-Sayama 589-8511, Japan
Author contributions: All authors helped to perform the research; Minaga K wrote the manuscript; Kitano M and Kudo M drafted the conception and design; Kitano M performed endoscopic interventions; Imai H, Yamao K, Kamata K, Miyata T, Omoto S, Kadosaka K and Yoshikawa T contributed to writing the manuscript.
Supported by The Japan Society for the Promotion of Science and the Japanese Foundation for the Research and Promotion of Endoscopy, No. 22590764 and 25461035.
Institutional review board statement: This study was approved by the Institutional Review Board of Kinki University Faculty of Medicine.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: All authors declare no conflicts-of-interest related to this article.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Masayuki Kitano, MD, PhD, Department of Gastroenterology and Hepatology, Kinki University Faculty of Medicine, 377-2 Ohno-Higashi, Osaka-Sayama 589-8511, Japan. m-kitano@med.kindai.ac.jp
Telephone: +81-72-3660221 Fax: +81-72-3672880
Received: December 10, 2015
Peer-review started: December 12, 2015
First decision: December 30, 2015
Revised: January 7, 2016
Accepted: January 30, 2016
Article in press: January 30, 2016
Published online: April 28, 2016
Processing time: 130 Days and 13.8 Hours
Abstract

Acute obstructive suppurative cholangitis (AOSC) due to biliary lithiasis is a life-threatening condition that requires urgent biliary decompression. Although endoscopic retrograde cholangiopancreatography (ERCP) with stent placement is the current gold standard for biliary decompression, it can sometimes be difficult because of failed biliary cannulation. In this retrospective case series, we describe three cases of successful biliary drainage with recovery from septic shock after urgent endoscopic ultrasound-guided choledochoduodenostomy (EUS-CDS) was performed for AOSC due to biliary lithiasis. In all three cases, technical success in inserting the stents was achieved and the patients completely recovered from AOSC with sepsis in a few days after EUS-CDS. There were no procedure-related complications. When initial ERCP fails, EUS-CDS can be an effective life-saving endoscopic biliary decompression procedure that shortens the procedure time and prevents post-ERCP pancreatitis, particularly in patients with AOSC-induced sepsis.

Keywords: Endoscopic ultrasound-guided biliary drainage; Choledochoduodenostomy; Acute obstructive suppurative cholangitis; Sepsis; Life-saving endoscopy

Core tip: We present 3 cases of urgent endoscopic ultrasound-guided choledochoduodenostomy (EUS-CDS) performed for acute obstructive suppurative cholangitis (AOSC)-induced sepsis due to benign lesions. In all three cases, technical success in inserting the stents was achieved and the patients completely recovered from AOSC with sepsis in a few days after EUS-CDS. Although endoscopic retrograde cholangiopancreatography (ERCP) with transpapillary stent placement is the current gold standard for biliary decompression, this technique is not always successful. In this situation, EUS-CDS can be an effective life-saving biliary decompression procedure that can shorten the procedure time and prevent post-ERCP pancreatitis, particularly in patients with AOSC-induced sepsis.