title: EUS-cholangio-drainage of the bile duct: report of 4 cases.
abstract: BACKGROUND
  Endoscopic retrograde cholangiography with stent insertion is an established procedure for palliation of patients with malignant pancreaticobiliary strictures. In some patients, however, placement of a stent by means of a duodenoscope is not possible. Percutaneous transhepatic biliary drainage is an alternative method that has a complication rate of up to 15%. Four cases of successful EUS-guided-cholangio-drainage are presented in which the major papilla could not be cannulated at endoscopic retrograde cholangiography.
  
  
  METHODS
  For puncture of the intrahepatic or extrahepatic bile duct, a modification of the one-step technique for the drainage of pancreatic pseudocysts was used.
  
  
  RESULTS
  Stent insertion was successful in 3 of the 4 patients. In these 3 patients cholestasis resolved promptly.
  
  
  CONCLUSIONS
  EUS-guided cholangio-drainage is a potential alternative to percutaneous transhepatic biliary drainage and endoscopic retrograde cholangiography in the therapy of malignant pancreaticobiliary strictures, especially in patients who have undergone gastrectomy or partial gastrectomy with Billroth II reconstruction.
authors.affiliation: Krankenhaus Sued, Abteilung für Gastroenterologie, Innere Medizin, Luebeck, Germany.
authors.forename: Eike
authors.initials: E
authors.lastname: Burmester
authors.forename: Jens
authors.initials: J
authors.lastname: Niehaus
authors.forename: Thomas
authors.initials: T
authors.lastname: Leineweber
authors.forename: Thomas
authors.initials: T
authors.lastname: Huetteroth
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001650:Bile Duct Neoplasms / Q000150:complications / Q000175:diagnosis; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000379:methods; D001651:Cholestasis, Extrahepatic / Q000000981:diagnostic imaging* / Q000209:etiology / Q000628:therapy*; D003287:Contrast Media; D004322:Drainage / Q000295:instrumentation* / Q000379:methods; D019160:Endosonography / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D010166:Palliative Care / Q000379:methods; D018570:Risk Assessment; D012494:Sampling Studies; D012720:Severity of Illness Index; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D003287:Contrast Media