title: EUS-guided transhepatic cholangiography: report of 6 cases.
abstract: BACKGROUND
  This report describes a novel application of EUS-guided cholangiography in which a transhepatic approach was used to alleviate perihilar and distal biliary obstructions when this could not be accomplished at ERCP.
  
  
  METHODS
  EUS-guided transhepatic cholangiography was used to alleviate symptoms of biliary obstruction in 6 patients. In 4 cases, after transgastric puncture of an intrahepatic branch of the obstructed bile duct with a 19- or a 22-gauge EUS needle, a guidewire was advanced antegrade across both the biliary stricture and the papilla. Subsequently, a rendezvous procedure was performed, allowing ERCP and stent placement.
  
  
  METHODS
  EUS-guided transhepatic cholangiography was performed in 6 patients, with successful rendezvous ERCP and stent placement in 4, and transduodenal stent placement in another patient. Stent placement was unsuccessful in one patient, because of the inability to advance a guidewire into the common hepatic duct. There was no immediate complication of the procedures.
  
  
  CONCLUSIONS
  EUS-guided transhepatic cholangiography can be used to access and to drain bile ducts that are obstructed by proximal, as well as distal lesions when ERCP is unsuccessful.
authors.forename: Michel
authors.initials: M
authors.lastname: Kahaleh
authors.forename: Pin
authors.initials: P
authors.lastname: Wang
authors.forename: Vanessa M
authors.initials: VM
authors.lastname: Shami
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Tokar
authors.forename: Paul
authors.initials: P
authors.lastname: Yeaton
mesh_terms: D000328:Adult; D002758:Cholangiography / Q000379:methods*; D002779:Cholestasis / Q000000981:diagnostic imaging* / Q000601:surgery; D019160:Endosonography / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged