We describe the case of a patient for whom
choledochoduodenostomy was performed under endoscopic
ultrasound (EUS) guidance as an alternative to
percutaneous transhepatic biliary drainage (PTBD) for the
treatment of obstructive jaundice. An 82-year-old man with
ampullary cancer was considered operable, but he refused
surgery. Endoscopic biliary drainage (EBD) with an 8.5-
French plastic stent was performed 2 months later because
of the development of obstructive jaundice. The EBD stent
was occluded 5 months after the stent insertion, and EUS
choledochoduodenostomy (EUS-CDS) was performed.
Pneumoperitoneum occurred 1 day after the procedure,
which resolved with conservative treatment. Six months
later, multiple lymph node metastases occurred, and the
patient was effectively treated by chemotherapy (S-1). The
patient is still alive with a good quality of life more than 2
years after EUS-CDS. We conclude that EUS-CDS is an
effective alternative to PTBD or EBD for patients with
malignant biliary obstruction, especially due to ampullary
cancer.