SINGLE-SESSION BRIDGE-TO-SURGERY CHOLEDOCHO-DUODENOSTOMY AND DUODENAL STENTING IN PATIENT WITH MALIGNANT BILIARY AND DUODENAL OBSTRUCTION

This´s the case of a 73-year-old-man affected by obstructive jaundice,cholangitis and vomit due to resectable pancreatic-head cancer. Secondary duodenal infiltration not allowed to reach the Vater’s papilla and choledocho-duodenostomy(EUS-CD)was performed. 8mm x 8mm LAMSwas deployed, obtaining biliary drainage. In the same session, uncovered 60mm x 10 mm SEMS was deployed across the 30 mm duodenal stenosis. CT-scan confirmed stents correct position. Progressive jaundice resolution was observed; the patient restarted oral feeding; he was referred to oncologic surgical treatment. In patients with malignant distal biliary and duodenal obstruction, single-session EUS-CD and duodenal stenting is challenging for the risk of LAMS dislocation,but feasible and effective. It doesn’t compromise further surgical treatment and it can be considered as a bridge-to-surgery approach.