Successful Trans-Cholecysto-Cystic Duct Common Bile Duct Stenting in a Case of Malignant Obstructive Jaundice

Malignant obstructive jaundice (MOJ) is a disease that could negatively affect patient outcomes. It is treated with Endoscopic Retrograde Cholangiopancreatography (ERCP), Percutaneous Transhepatic Biliary drainage (PTBD), or Endoscopic ultrasound-guided biliary drainage (EUS-BD). We here present a case where malignant obstructive jaundice that failed both ERCP and PTBD achieved successful biliary decompression through trans-cholecysto-cystic duct CBD stenting. A-53-year old female presented to our center with obstructive jaundice secondary to a pancreatic uncinate tumor. Multiple attempts of ERCP and PTBD failed due to difficult cannulation and inadequate dilation of IHD. Furthermore, EUS-BD expertise was not available in our center. A percutaneous cholecystostomy was performed for temporary biliary decompression. After a multidisciplinary discussion was made, the decision was made for trans-cholecystic-cystic duct CBD stenting. The procedure was a success without significant complications. There are multiple ways for biliary decompression. ERCP and PTBD are most commonly used as the first-line treatment with a high success rate. However, PTBD is associated with more complications, with a morbidity rate of up to 33%. With the advancement of EUS, EUS-BD has been a popular treatment option with similar technical success. However, it is a complex and risky procedure that requires expertise. In this case, we achieved a biliary decompression technique similar to PTBD. Instead, the gallbladder and cystic duct are used as passage for stenting. The result is better than envisaged with successful biliary decompression without complications. In conclusion, trans-cholecysto-cystic duct biliary stenting is a feasible procedure to be done for biliary decompression.