title: EUS-guided antegrade transhepatic placement of a self-expandable metal stent in hepatico-jejunal anastomosis.
abstract: BACKGROUND
  To demonstrate an EUS-guided biliary drainage in patient with gastrointestinal tract modified surgically.
  
  
  METHODS
  An EUS guided access to the left intra hepatic duct, followed by an antegrade passage of a partially self-expandable metal stent that was removed by using an enteroscope, in one patient with hepatico-jejunal anastomosis. There were no early or delayed complications and the procedure was effective in relieving jaundice until the self-expandable metal stent was removed, 3 months later. A cholangiogram was obtained via enteroscopy, after removal of self-expandable metal stent, and found to be normal. The patient had an uneventful evaluation afterwards.
  
  
  CONCLUSIONS
  The indication of these procedures must be made under a multidisciplinary view while sharing information with the patient or legal guardian. EUS-guided biliary drainage is feasible when performed by professionals with expertise in biliopancreatic endoscopy and advanced echo-endoscopy and should be performed currently under rigorous protocol in educational institutions.
authors.affiliation: University of São Paulo, São Paulo, SP, Brazil. eartifon@hotmail.com
authors.forename: Everson L A
authors.initials: EL
authors.lastname: Artifon
authors.forename: Adriana Vaz
authors.initials: AV
authors.lastname: Safatle-Ribeiro
authors.forename: Flávio Coelho
authors.initials: FC
authors.lastname: Ferreira
authors.forename: Luiz
authors.initials: L
authors.lastname: Poli-de-Figueiredo
authors.forename: Samir
authors.initials: S
authors.lastname: Rasslan
authors.forename: Francisco
authors.initials: F
authors.lastname: Carnevale
authors.forename: José Pinhata
authors.initials: JP
authors.lastname: Otoch
authors.forename: Paulo
authors.initials: P
authors.lastname: Sakai
authors.forename: Michel
authors.initials: M
authors.lastname: Kahaleh
mesh_terms: D000713:Anastomosis, Roux-en-Y; D001662:Biliary Tract Surgical Procedures / Q000379:methods*; D005260:Female; D006801:Humans; D007582:Jejunostomy; D007583:Jejunum / Q000601:surgery*; D008099:Liver / Q000601:surgery*; D008670:Metals; D008875:Middle Aged; D015607:Stents; D015625:Tissue Expansion Devices; D018084:Ultrasonography, Interventional / Q000379:methods
chemical_list: D008670:Metals