EUS-Guided Choledocho-Duodenostomy (CDS) is an advanced, minimally invasive endoscopic procedure used to relieve bile duct obstruction when conventional ERCP is not feasible or has failed. This technique is performed using endoscopic ultrasound (EUS) guidance to create a direct connection between the common bile duct (choledochus) and the duodenum, allowing effective internal biliary drainage without the need for external tubes or open surgery.

During the procedure, an endoscopic ultrasound probe is used to precisely visualize the dilated bile duct through the wall of the duodenum. Under real-time imaging, a controlled access is created, and a specialized stent—most commonly a lumen-apposing metal stent (LAMS)—is placed to establish a secure passage for bile to drain directly into the intestine. This ensures accurate placement, minimizes injury to surrounding structures, and significantly reduces procedural complications.

EUS-guided CDS is particularly beneficial for patients with malignant biliary obstruction caused by pancreatic cancer, cholangiocarcinoma, or periampullary tumors, as well as in selected benign strictures. It is an excellent alternative for patients who are not suitable candidates for surgery or percutaneous biliary drainage, offering faster recovery, improved comfort, and better quality of life.

The advantages of EUS-guided Choledocho-Duodenostomy include high technical and clinical success rates, avoidance of external drainage catheters, reduced risk of infection, and shorter hospital stays. As the procedure is minimally invasive, patients typically experience less pain and can resume normal activities sooner compared to traditional surgical approaches.

With advancements in endoscopic technology and expertise, EUS-guided CDS has become a safe and effective solution for complex biliary drainage. When performed by experienced gastroenterologists, it provides reliable long-term relief from jaundice, pruritus, and other symptoms associated with biliary obstruction, making it a valuable option in modern therapeutic endoscopy.