Endosonography-guided biliary drainage in cases with difficult transpapillary endoscopic biliary drainage.
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.
Horaguchi
Jun
J
Department of Gastroenterology, Sendai City Medical Center, Miyagino-ku, Sendai, Japan. j-hora@qg7.so-net.ne.jp
Fujita
Naotaka
N
Noda
Yutaka
Y
Kobayashi
Go
G
Ito
Kei
K
Obana
Takashi
T
Takasawa
Osamu
O
Koshita
Shinsuke
S
Kanno
Yoshihide
Y
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