title: Endosonography-guided biliary drainage in cases with difficult transpapillary endoscopic biliary drainage.
abstract: BACKGROUND
  Recently, reports on a new endoscopic biliary drainage technique utilizing endosonographic guidance (endosonography-guided biliary drainage [ESBD]) have been increasing. The aim of this study was to evaluate the efficacy of ESBD in cases with difficult transpapillary endoscopic biliary drainage (EBD).
  
  
  METHODS
  Sixteen patients with obstructive jaundice who underwent ESBD because of difficult EBD between January 2007 and September 2008 were included. The technical success, complications, and clinical efficacy of ESBD were prospectively evaluated.
  
  
  RESULTS
  ESBD was performed via the duodenum, stomach, and esophagus in eight, six and two patients, respectively. Stent placement was successful in all cases and excellent biliary decompression was achieved in all but one patient. One patient developed localized peritonitis following guidewire migration and re-puncture of the bile duct. In another patient, stent migration was observed one week after ESBD and re-ESBD was carried out. Three patients underwent surgery for their primary diseases, and stent exchange was carried out in 10 patients during the course.
  
  
  CONCLUSIONS
  ESBD is an effective treatment for obstructive jaundice that will replace percutaneous transhepatic biliary drainage in cases of difficult EBD and is a possible alternative to EBD in selected cases.
authors: Department of Gastroenterology, Sendai City Medical Center, Miyagino-ku, Sendai, Japan. j-hora@qg7.so-net.ne.jp
authors: Jun
authors: J
authors: Horaguchi
authors: Naotaka
authors: N
authors: Fujita
authors: Yutaka
authors: Y
authors: Noda
authors: Go
authors: G
authors: Kobayashi
authors: Kei
authors: K
authors: Ito
authors: Takashi
authors: T
authors: Obana
authors: Osamu
authors: O
authors: Takasawa
authors: Shinsuke
authors: S
authors: Koshita
authors: Yoshihide
authors: Y
authors: Kanno
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004322:Drainage / Q000379:methods*; D004724:Endoscopy; D019160:Endosonography; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D041781:Jaundice, Obstructive / Q000209:etiology / Q000473:pathology* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D015607:Stents; D025321:Surgery, Computer-Assisted; D016896:Treatment Outcome