title: EUS-guided biliary drainage with placement of a new partially covered biliary stent for palliation of malignant biliary obstruction: a case series.
abstract: Endoscopic ultrasonography-guided biliary drainage (EUS-BD) has been developed as an alternative drainage technique in patients with obstructive jaundice where endoscopic retrograde cholangiopancreatography (ERCP) has failed. Between July 2008 and December 2009, 16 patients (9 men; median age 79 years) with biliopancreatic malignancy, who were candidates for alternative techniques of biliary decompression because ERCP had been unsuccessful, underwent EUS-BD with placement of a transmural or transpapillary partially covered nitinol self-expandable metal stent (SEMS). EUS-assisted cholangiography was successful in all patients, with definition of the relevant anatomy, but biliary drainage was successfully performed in only 12 (75 %) of the 16 patients (9 choledochoduodenostomies with SEMS placement and 3 biliary rendezvous procedures with papillary SEMS placement), with regression of the cholestasis. No major complications and no procedure-related deaths occurred. There was one case of pneumoperitoneum which was managed conservatively. The median follow-up was 170 days. During the follow-up, eight patients of the 12 patients in whom biliary draining was successful died; four are currently alive. None of the patients required endoscopic reintervention. This series demonstrated that EUS-BD with a partially covered SEMS has a high rate of clinical success and low complication rates, and could represent an alternative choice for biliary decompression.
authors.affiliation: Unit of Gastroenterology and Digestive Endoscopy, AUSL Bologna Bellaria-Maggiore Hospital, Largo Nigrisoli 2, Bologna, Italy. carlo.fabbri@ausl.bologna.it
authors.forename: C
authors.initials: C
authors.lastname: Fabbri
authors.forename: C
authors.initials: C
authors.lastname: Luigiano
authors.forename: L
authors.initials: L
authors.lastname: Fuccio
authors.forename: A M
authors.initials: AM
authors.lastname: Polifemo
authors.forename: F
authors.initials: F
authors.lastname: Ferrara
authors.forename: S
authors.initials: S
authors.lastname: Ghersi
authors.forename: M
authors.initials: M
authors.lastname: Bassi
authors.forename: P
authors.initials: P
authors.lastname: Billi
authors.forename: A
authors.initials: A
authors.lastname: Maimone
authors.forename: V
authors.initials: V
authors.lastname: Cennamo
authors.forename: M
authors.initials: M
authors.lastname: Masetti
authors.forename: E
authors.initials: E
authors.lastname: Jovine
authors.forename: N
authors.initials: N
authors.lastname: D'Imperio
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001650:Bile Duct Neoplasms / Q000150:complications; D002404:Catheterization; D002779:Cholestasis / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D004322:Drainage / Q000379:methods*; D016145:Endoscopy, Digestive System / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D015607:Stents; D016896:Treatment Outcome; D014463:Ultrasonography