A case of unresectable pancreatic carcinoma treated by chemotherapy, endosonography-guided biliary drainage, and endoscopic duodenal stent placement

Abstract

We report a case of unresectable advanced pancreatic cancer in which transgastric endosonography-guided biliary drainage (ESBD) and endoscopic duodenal stenting provided good QOL, allowing continuation of chemotherapy. A 78-year-old man was admitted to our department with a diagnosis of unresectable pancreatic carcinoma with liver metastasis and obstructive jaundice. As endoscopic biliary drainage was not possible because of duodenal stenosis caused by cancer invasion, transgastric ESBD was performed. His jaundice subsided and chemotherapy was started. During the course, duodenal obstruction developed, which was treated with endoscopic duodenal stent placement. These endoscopic treatments enabled continuation of chemotherapy for 6 months until his death. ESBD is a useful technique for biliary drainage in difficult endoscopic biliary drainage cases and endoscopic duodenal stent placement contributes to the improvement of patients QOL.