title: Endocoil placement after endoscopic ultrasound-guided biliary drainage may prevent a bile leak.
abstract: OBJECTIVE
  To further reduce the risk of bleeding or bile leakage.
  
  
  METHODS
  We performed endoscopic ultrasound guided biliary drainage in 6 patients in whom endoscopic retrograde cholangiopancreatography (ERCP) had failed. Biliary access of a dilated segment 2 or 3 duct was achieved from the stomach using a 19G needle. After radiologically confirming access a guide wire was placed, a transhepatic tract created using a 6 Fr cystotome followed by balloon dilation of the stricture and antegrade metallic stent placement across the malignant obstruction. This was followed by placement of an endocoil in the transhepatic tract.
  
  
  RESULTS
  Dilated segmental ducts were observed in all patients with the linear endoscopic ultrasound scope from the proximal stomach. Transgastric biliary access was obtained using a 19G needle in all patients. Biliary drainage was achieved in all patients. Placement of an endocoil was possible in 5/6 patients. All patients responded to biliary drainage and no complications occurred.
  
  
  CONCLUSIONS
  We show that placing endocoils at the time of endoscopic ultrasound guided biliary stenting is feasible and may reduce the risk of bleeding or bile leakage.
authors.affiliation: Schalk Willem van der Merwe, Hepatology and GI Research Laboratory, Department of Immunology, University of Pretoria, Pretoria 0002, South Africa.
authors.forename: Schalk Willem
authors.initials: SW
authors.lastname: van der Merwe
authors.forename: Jones
authors.initials: J
authors.lastname: Omoshoro-Jones
authors.forename: Charles
authors.initials: C
authors.lastname: Sanyika
keywords: Biliary drainage; Endocoil; Endoscopic ultrasound; Transhepatic