EUS-Directed transDuodenal ERCP in Concomitant Gastric Outlet and Biliary Obstruction

Background and aims: Patients with concomitant gastric outlet obstruction (GOO) and biliary obstruction often have limited management options, particularly in the setting of severe debility. We detail the use of EUS guided gastro-duodenal placement of lumen apposing metal stent (LAMS) as a conduit for transduodenal ERCP: EUS-Directed transDuodenal ERCP (EDDE).

Methods: Nine patients that developed GOO with indwelling biliary metal stents or with anticipated biliary stent placement were retrospectively included.

Results: A 20 mm x 10 mm LAMS deployed for creation of gastroduodenostomy in all patients. ERCP was performed via the gastroduodenal LAMS with resolution of jaundice in 100% of patients. GOOSS score improved to 3 in all patients.

Conclusions: This study demonstrates excellent outcomes (resolution of jaundice and GOO) in all chronically ill, poor surgical candidates. LAMS allowed for both, treatment of GOO and for ERCP access for present and future stent exchange.