Endoscopic ultrasound-guided bilioduodenal anastomosis: a new technique for biliary drainage.
Endoscopic biliary stenting is the most common method of treating obstructive jaundice. We present a new technique of biliary drainage using endoscopic ultrasound (EUS) and EUS-guided puncture of the common bile duct (CBD). A 56-year-old man with obstructive jaundice was referred for EUS and endoscopic retrograde cholangiopancreatography (ERCP) because a computed tomography (CT) scan had shown a pancreatic mass in the head of the pancreas and a dilated CBD. The patient was enrolled in a preoperative chemoradiotherapy protocol and biliary stenting was required. Deep cannulation was not obtained even after a precut and the procedure was stopped. Using a therapeutic EUS scope (FG 38X Pentax), the CBD was punctured with a 5-F needle-knife under EUS guidance and a cholangiogram was obtained. A 0.35-inch guide wire was introduced into the CBD. The EUS scope was removed and a duodenoscope was introduced, allowing the placement through the duodenum of a 10-F plastic stent. The CBD was drained properly. No complication occurred.
Giovannini
M
M
Endoscopy Unit, Paoli-Calmettes Institute, Marseilles, France. hdjchir@marseille.fnclcc.fr
Moutardier
V
V
Pesenti
C
C
Bories
E
E
Lelong
B
B
Delpero
J R
JR
D000230:Adenocarcinoma / Q000150:complications*; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000379:methods; D002779:Cholestasis / Q000000981:diagnostic imaging / Q000601:surgery*; D003135:Common Bile Duct; D004322:Drainage; D019160:Endosonography / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000150:complications*; D016577:Pancreaticoduodenectomy / Q000379:methods; D011677:Punctures / Q000379:methods; D015607:Stents; D018084:Ultrasonography, Interventional / Q000379:methods*