title: EUS-guided drainage of bilomas: a new alternative?
abstract: BACKGROUND
  Bilomas have traditionally been treated by either percutaneous drainage or surgery. However, percutaneous drainage is associated with discomfort and infection, whereas surgery, which is usually reserved for refractory cases, has high morbidity and mortality rates. Recently, endoscopic drainage of bilomas adjacent to the GI lumen has been reported in isolated reports.
  
  
  OBJECTIVE
  We analyzed our 4 years' experience with this innovative technique.
  
  
  METHODS
  Patients with symptomatic bilomas were offered EUS-guided drainage and were followed up prospectively for clinical and radiologic responses.
  
  
  METHODS
  Tertiary care center with long-standing experience in EUS-guided drainage.
  
  
  METHODS
  A total of 5 patients underwent EUS-guided transenteric drainage of symptomatic bilomas.
  
  
  METHODS
  The technique included transenteric EUS-guided puncture, placement of a guidewire into the biloma, and creation of an enteral-biloma fistula with placement of a plastic endoprosthesis after balloon dilation. In 4 cases, the stents were removed at a mean of 6.8 +/- 4.3 weeks. In one patient with malignancy, the stent was left in place for palliation.
  
  
  METHODS
  Efficacy and safety of EUS-guided drainage of bilomas.
  
  
  RESULTS
  EUS-guided transenteric biloma drainage was successfully performed in 5 patients without any significant morbidity. Biloma resolution was confirmed in all 5 patients, and none of the 4 patients relapsed after stent removal (mean follow-up of 12.8 +/- 6.1 months).
  
  
  CONCLUSIONS
  EUS-guided drainage of bilomas is technically feasible, appears safe, and provides an attractive alternative to percutaneous or surgical drainage.
authors.affiliation: Charlottesville, Virginia, USA.
authors.forename: Vanessa M
authors.initials: VM
authors.lastname: Shami
authors.forename: Jayant P
authors.initials: JP
authors.lastname: Talreja
authors.forename: Anshu
authors.initials: A
authors.lastname: Mahajan
authors.forename: Melissa S
authors.initials: MS
authors.lastname: Phillips
authors.forename: Paul
authors.initials: P
authors.lastname: Yeaton
authors.forename: Michel
authors.initials: M
authors.lastname: Kahaleh
mesh_terms: D000328:Adult; D000368:Aged; D001660:Biliary Tract Diseases / Q000000981:diagnostic imaging / Q000601:surgery*; D002404:Catheterization; D004322:Drainage / Q000379:methods*; D016145:Endoscopy, Digestive System / Q000379:methods*; D019160:Endosonography; D005260:Female; D006801:Humans; D008297:Male; D015607:Stents; D014057:Tomography, X-Ray Computed