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After ERCP could not relieve the biliary obstruction, the patient deteriorated rapidly. Following stabilization with fluids and vasopressors, an 8mm×6mm self-expandable metal stent and a naso-biliary catheter enabled continuous irrigation, leading to prompt biomarker improvement and successful weaning of vasopressors, with discharge at two weeks.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/endoscopic-ultrasound-guided-choledochoduodenostomy-as-a-life-saving-salvage-therapy-for-post-transplant-acute-biliary-obstruction/459161/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/endoscopic-ultrasound-guided-choledochoduodenostomy-as-a-life-saving-salvage-therapy-for-post-transplant-acute-biliary-obstruction/459161.png","ImageObject",300,407,{"name":92,"@type":93},"MrHarris58","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-11-07","2026-09-30",true,{"@type":102,"interactionType":103,"userInteractionCount":29},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"Why was EUS-guided choledochoduodenostomy chosen in this case?","Question",{"text":112,"@type":113},"EUS-CDS was selected because ERCP failed to relieve post-transplant biliary obstruction and percutaneous drainage became inadequate due to catheter migration.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"What was placed during the EUS-CDS procedure?",{"text":117,"@type":113},"An 8mm×6mm self-expandable metal stent was deployed between the dilated common bile duct and the duodenal bulb, followed by placement of an 8.5-Fr naso-biliary catheter for continuous irrigation.",{"name":119,"@type":110,"acceptedAnswer":120},"What clinical improvements were observed after EUS-CDS?",{"text":121,"@type":113},"Within 72 hours, procalcitonin and C-reactive protein levels decreased substantially, hemodynamic stability returned, vasopressors were weaned, and the patient was discharged in stable condition two weeks postoperatively.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},459161,1790755305,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":29,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":14,"language":139,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":67,"update_tm":129,"read_time":24,"preview_page_count":4},687212988360,"https://ap-avatar.wpscdn.com/davatar_276721f389ce27ea32af1340a28f341c","Article published online: 2026-01-08  \nEndoscopic ultrasound-guided choledochoduodenostomyas a life-saving salvage therapy for post-transplant acute biliary obstruction  \nVideo 1 Procedure of endoscopic ultrasound-guided choledochoduodenostomy using a self-expandable metalstent.  \nEndoscopic ultrasound-guided biliary drainage (EUS-BD) has become a recognized and effective alternative to conventional retrograde biliary drainage methods, such as endoscopic retrograde cholangiopancreatography (ERCP [1,2]) . While endoscopic ultrasound (EUS) is occasionally employed for diagnosing complications following liver transplantation, the feasibility of EUS-guided interventions for managing post-transplant complications has been documented in only a limited number of case reports [3–5] . We report the first case in which endoscopic ultrasound-guided choledochoduodenostomy (EUS-CDS) was successfully utilized as an emergency intervention in a liver transplant recipient with septic shock, following the failure of ERCP.  \nWe report the case of a 61-year-old man who developed cholestatic jaundice and pruritus 1 year after orthotopic liver transplantation. Magnetic resonance cholangiopancreatography revealed ahilar biliary stricture. The patient under-  \n▶Fig. 1 Endoscopic ultrasound-guided choledochoduodenostomy (EUS-CDS) for post-transplant biliary obstruction. a Endoscopic retrograde cholangiopancreatography (ERCP) failed to place a biliary stent; however, a pancreatic duct stent was placed successfully. b and c EUS-CDS with successful stent deployment. d A naso-biliary catheter was placed in the bile duct through the stent, and fluoroscopy confirmed the absence of leakage.  \nwent percutaneous transhepatic cholangiography drainage; however, catheter migration led to inadequate biliary drainage and persistent jaundice. Subsequent ERCP included the placement of a pancreatic duct stent but failed to relieve the biliary obstruction ( ▶ Fig.1a) . The patient rapidly progressed to septic shock following the procedure. After fluid resuscitation and vasopressor support, EUS-CDS was performed. An 8mm×6mm self-expandable metal stent was deployed between the dilated common bile duct and the duodenal bulb,  \nand an 8.5-Fr naso-biliary catheter was inserted into the bile duct to enable continuous irrigation ( ▶Video 1 , ▶ Fig. 1 b–d) .  \nWithin 72 hours following the procedure, procalcitonin fell from >100ng/mL to 12.7µmol/L, and C-reactive protein decreased from 122.4 to 20.3mg/L. Haemodynamic stability was restored, and vasopressors were weaned off. The patient was discharged home in stable condition 2 weeks postoperatively.  \nTo the best of our knowledge, this case represents the first reported instance in  \nSong Yiran et al. Endoscopic ultrasound-guided choledochoduodenostomy… Endoscopy 2026; 58: E7–E8 | © 2026. The Author(s) . E7  \nwhich EUS-CDS can serve as a life-saving and minimally invasive rescue therapy for septic biliary obstruction when both conventional ERCP and percutaneous approaches have failed in a post-liver transplant patient. This finding may broaden the indications for EUS-BD in post-surgical patients with altered anatomy and life-threatening sepsis, establishing it as a viable emergent therapeutic option.  \nEndoscopy_UCTN_Code_TTT_ 1AS_ 2AD  \nContributors ʼ Statement  \nYiran Song: Writing – original draft, Writing – review & editing. Bixiong Zhang: Data curation, Investigation, Supervision, Validation. Yue Sun: Data curation, Methodology, Validation. Yue Li: Conceptualization, Methodology, Resources, Supervision.  \nConflict of Interest  \nThe authors declare that they have no conflict of interest.  \nThe authors  \n\n| Yiran Song1, Bixiong Zhang2, Yue Sun2, Yue Li2 \u003Cbr>1 Department of Gastroenterology, The Affiliated Taizhou People ʼ s Hospital of Nanjing Medical University, Taizhou School of Clinical Medicine, Nanjing Medical University, Taizhou, China\u003Cbr>2 Endoscopy Center, Guangdong Provincial People ʼ s Hospital, Guangdong Academy ","cbCaikafGbOK9QxX","https://ap.wps.com/l/cbCaikafGbOK9QxX","pdf",2749808,"English","# Background\n# Case presentation\n## Initial transplant complication and failed ERCP\n## Progression to septic shock\n# Rescue intervention: EUS-CDS procedure\n## Stent deployment and naso-biliary irrigation\n# Outcomes and clinical follow-up\n# Authors and declarations","[{\"question\":\"Why was EUS-guided choledochoduodenostomy chosen in this case?\",\"answer\":\"EUS-CDS was selected because ERCP failed to relieve post-transplant biliary obstruction and percutaneous drainage became inadequate due to catheter migration.\"},{\"question\":\"What was placed during the EUS-CDS procedure?\",\"answer\":\"An 8mm×6mm self-expandable metal stent was deployed between the dilated common bile duct and the duodenal bulb, followed by placement of an 8.5-Fr naso-biliary catheter for continuous irrigation.\"},{\"question\":\"What clinical improvements were observed after EUS-CDS?\",\"answer\":\"Within 72 hours, procalcitonin and C-reactive protein levels decreased substantially, hemodynamic stability returned, vasopressors were weaned, and the patient was discharged in stable condition two weeks postoperatively.\"}]","Endoscopic ultrasound-guided choledochoduodenostomy as a life-saving salvage therapy for post-transplant acute biliary obstruction | PDF"]