Endoscopy 2008; 40(4): 336-339
DOI: 10.1055/s-2007-995455
Case report

© Georg Thieme Verlag KG Stuttgart · New York

EUS-guided biliary drainage: a case series

I.  Tarantino1 , L.  Barresi1 , A.  Repici2 , M.  Traina1
  • 1Department of Gastroenterology, IsMeTT/UPMC, Palermo, Italy
  • 2Department of Gastroenterology, Istituto Clinico Humanitas, Milan, Italy
Further Information

Publication History

submitted 20 July 2007

accepted after revision 20 November 2007

Publication Date:
11 February 2008 (online)

Introduction

Endoscopic retrograde cholangiopancreatography (ERCP) is the most appropriate technique to treat common bile duct and pancreatic duct stenosis secondary to benign and malignant diseases. Biliary and/or pancreatic duct cannulation and visualization are successful with ERCP in a high percentage of cases managed by experienced hands [1] [2] [3]. Common causes of failure include complex peripapillary diverticula, prior surgery procedures such as gastrectomy with Billroth II anastomosis, tumor involvement of the papilla, biliary sphincter stenosis, and impacted stones [4].

Percutaneous transhepatic cholangiography (PTC) [5] and surgery are the alternative approaches to access and drain obstructed ducts. The development of the large channel linear array echoendoscope allows for therapeutic procedures such as fine needle aspiration (FNA) and biopsy [6], celiac plexus neurolysis [7], pancreatic pseudocyst [8], and perirectal and retroperitoneal abscess drainage [9].

Since 1996 when Wiersema et al. first described endoscopic ultrasound (EUS)-guided bile duct puncture [10], several case reports have been published on EUS-guided biliary and pancreatic duct puncture and drainage [11] [12] [13] [14] [15] [16] [17] [18] [19]. These case reports illustrate different techniques to approach bile and pancreatic ducts: transgastric or transduodenal puncture, rendezvous after positioning a guide wire through the papilla, or creating a new papilla by fistula formation. In all of these reports, interventional EUS proved feasible and safe with a low rate of complications, but only few series have been published.

Kahaleh et al. have recently described a series of 23 patients treated with interventional endoscopic ultrasound cholangiography (IEUC). Biliary decompression was accomplished in more than 90 % of the cases that had previously received ERCP without success; in one of these cases, bile leakage occurred using the extrahepatic approach [20].

We describe a series of consecutive patients in whom ERCP failed for different reasons ([Table 1]), and IEUC was applied instead of the traditional percutaneous approach.

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I. Tarantino,MD 

Department of Gastroenterology
Mediterranean Institute for Transplantation and Advanced Specialized Therapies

Via tricomi
Palermo 90100
Italy

Fax: +39-091-6665340

Email: itarantino@ismett.edu