title: EUS-guided biliary drainage with a fully covered metal stent as a novel route for natural orifice transluminal endoscopic biliary interventions: a pilot study (with videos).
abstract: BACKGROUND
  EUS-guided biliary drainage (EUS-BD) with the use of a fully covered metal stent can result in a large-diameter fistula between the bile duct and the duodenum or stomach. This sustainable fistula may constitute a new endoscopic route to the bile duct.
  
  
  OBJECTIVE
  To assess the feasibility of performing endoscopic procedures through EUS-guided choledochoduodenostomy or hepaticogastrostomy with a fully covered self-expandable metal stent (FCSEMS).
  
  
  METHODS
  Observational pilot study.
  
  
  METHODS
  Tertiary-care referral center.
  
  
  METHODS
  This study involved 3 consecutive patients who underwent EUS-BD with an FCSEMS for biliary decompression.
  
  
  METHODS
  One to four weeks after EUS-BD with an FCSEMS, endoscopic procedures for the bile duct were performed through the sinus tract to evaluate and manage intrabiliary lesions.
  
  
  METHODS
  Technical success and procedural complications of endoscopic procedures through EUS-BD with an FCSEMS.
  
  
  RESULTS
  Endoscopic procedures were completed through the sinus tract of EUS-BD. Two patients underwent photodynamic therapy for tumor bleeding in the common bile duct and argon plasma coagulation on the biliary intraductal papillary mucinous neoplasm repeatedly under direct visual guidance. In the other patient, photodynamic therapy was performed on the malignant hilar stricture through EUS-guided hepaticogastrostomy with an FCSEMS.
  
  
  CONCLUSIONS
  Small sample size, pilot study.
  
  
  CONCLUSIONS
  EUS-BD with an FCSEMS may result in a large-diameter sustainable fistula. Endoscopic intervention through this fistula seems to be feasible and useful for the management of intrabiliary lesions.
authors.affiliation: Department of Internal Medicine, University of Ulsan College of Medicine, Ulsan University Hospital, Ulsan, Korea.
authors.forename: Junbum
authors.initials: J
authors.lastname: Eum
authors.forename: Do Hyun
authors.initials: DH
authors.lastname: Park
authors.forename: Choong Heon
authors.initials: CH
authors.lastname: Ryu
authors.forename: Hong Jun
authors.initials: HJ
authors.lastname: Kim
authors.forename: Sang Soo
authors.initials: SS
authors.lastname: Lee
authors.forename: Dong Wan
authors.initials: DW
authors.lastname: Seo
authors.forename: Sung Koo
authors.initials: SK
authors.lastname: Lee
authors.forename: Myung-Hwan
authors.initials: MH
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D057908:Argon Plasma Coagulation; D001650:Bile Duct Neoplasms / Q000628:therapy; D001653:Bile Ducts, Intrahepatic; D002291:Carcinoma, Papillary / Q000628:therapy; D002760:Cholangiopancreatography, Endoscopic Retrograde; D020099:Coated Materials, Biocompatible; D003138:Common Bile Duct Neoplasms / Q000628:therapy; D004322:Drainage / Q000379:methods*; D019160:Endosonography / Q000379:methods*; D005260:Female; D006431:Hemobilia / Q000628:therapy; D006801:Humans; D018285:Klatskin Tumor / Q000628:therapy; D008875:Middle Aged; D057605:Natural Orifice Endoscopic Surgery / Q000379:methods*; D010778:Photochemotherapy / Q000379:methods; D010865:Pilot Projects; D015607:Stents; D018084:Ultrasonography, Interventional / Q000379:methods*
chemical_list: D020099:Coated Materials, Biocompatible