title: Interventional EUS-guided cholangiography: evaluation of a technique in evolution.
abstract: BACKGROUND
  Interventional EUS-guided cholangiography (IEUC) has been increasingly used as an alternative to percutaneous transhepatic cholangiography (PTC) in cases of biliary obstruction when ERCP is unsuccessful.
  
  
  OBJECTIVE
  We reviewed our experience and technique used for this procedure.
  
  
  METHODS
  Over a 3-year period, ending July 2005, patients with a failed ERCP were offered an IEUC.
  
  
  METHODS
  Tertiary care center offering ERCP and interventional EUS.
  
  
  METHODS
  Twenty-eight patients were candidates for IEUC. Two patients had bleeding masses and were referred to interventional radiology, 1 patient had a large mass occupying the duodenal lumen, and 2 patients refused IEUC.
  
  
  METHODS
  EUS was used to access the biliary system after which a guidewire was advanced antegrade across the obstruction. Either rendezvous with retrograde or antegrade drainage was then accomplished.
  
  
  METHODS
  Efficacy and safety of IEUC for biliary decompression.
  
  
  RESULTS
  IEUC was successfully performed in 23 patients, with a transgastric-transhepatic (intrahepatic) approach in 13 cases and transenteric-transcholedochal (extrahepatic) approach in 10 cases. Therapeutic benefit was achieved in 21 patients: 18 underwent successful stent deployment across the stricture, whereas 3 patients required a choledochoenteric fistula formation. Complications included 1 case of bile leak, 2 cases of self-limited pneumoperitoneum, and 1 case of minor bleeding.
  
  
  CONCLUSIONS
  Single-center experience of 2 operators.
  
  
  CONCLUSIONS
  IEUC appears efficacious in patients in whom ERCP is unsuccessful and is evolving as an attractive alternative to PTC. Intrahepatic access to the biliary system appears safer than the extrahepatic approach.
authors.affiliation: Digestive Health Center of Excellence, University of Virginia Health System, Charlottesville, VA 22908, USA.
authors.forename: Michel
authors.initials: M
authors.lastname: Kahaleh
authors.forename: Alfredo J
authors.initials: AJ
authors.lastname: Hernandez
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Tokar
authors.forename: Reid B
authors.initials: RB
authors.lastname: Adams
authors.forename: Vanessa M
authors.initials: VM
authors.lastname: Shami
authors.forename: Paul
authors.initials: P
authors.lastname: Yeaton
mesh_terms: D000368:Aged; D001660:Biliary Tract Diseases / Q000000981:diagnostic imaging*; D002758:Cholangiography / Q000379:methods*; D002760:Cholangiopancreatography, Endoscopic Retrograde; D019160:Endosonography; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D008297:Male; D008875:Middle Aged; D015641:Radiography, Interventional / Q000379:methods*; D012189:Retrospective Studies; D017211:Treatment Failure