Endoscopic ultrasound guided therapy of benign and malignant biliary obstruction: a case series.
OBJECTIVE
Endoscopic retrograde cholangiography is an established method for treatment of common bile duct stones as well as for palliation of patients with malignant pancreaticobiliary strictures. It may be unsuccessful in the presence of a complex peripapillary diverticulum, prior surgery, obstructing tumor, papillary stenosis, or impacted stones. Percutaneous transhepatic biliary drainage and surgery are alternative methods with a higher morbidity and mortality in these cases. Recently, endoscopic ultrasound (EUS) guided biliary stent placement has been described in patients with malignant biliary obstruction. We describe our experience with this method that was also used for the treatment of cholangiolithiasis for the first time.


METHODS
The EUS guided transduodenal puncture of the common bile duct with stent placement was performed in 5 patients. In 2 of these patients, the stents were removed after several weeks and common bile duct stones were extracted. In another patient with gastrectomy, the left intrahepatic bile duct was punctured transjejunally and a metal stent was introduced transhepatically to bridge a distal common bile duct stenosis.


RESULTS
Biliary decompression was successful in all 6 patients. No immediate complications occurred. One patient developed a subacute phlegmonous cholecystitis.


CONCLUSIONS
Interventional EUS guided biliary drainage is a new technique that allows drainage of the biliary system in benign and malignant diseases when the bile duct is inaccessible by conventional ERCP.
Püspök
Andreas
A
Department of Internal Medicine IV, Division of Gastroenterology, Medical University Vienna, Austria.
Lomoschitz
Friedrich
F
Dejaco
Clemens
C
Hejna
Michael
M
Sautner
Thomas
T
Gangl
Alfred
A
D000368:Aged; D000369:Aged, 80 and over; D001652:Bile Ducts; D002760:Cholangiopancreatography, Endoscopic Retrograde; D002779:Cholestasis / Q000209:etiology / Q000628:therapy*; D003137:Common Bile Duct Diseases / Q000209:etiology / Q000628:therapy; D004322:Drainage; D019160:Endosonography; D005260:Female; D042882:Gallstones / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000150:complications; D015607:Stents; D018084:Ultrasonography, Interventional