title: Cannulation of the biliary tree under endoscopic control with an echoendoscope, without fluoroscopy: report of a case series.
abstract: BACKGROUND
  Endoscopic ultrasonography (EUS) is a validated technique allowing precise diagnosis and staging of pancreatic, biliary and ampullary disease. Developments in instruments and accessories have led to a more extensive use of this technology to perform operations. The use of EUS as an operative technique, alone or in conjunction with other endoscopic procedures, has already been described in the literature in several reports. However, despite the use of EUS, fluoroscopy has always been required to perform these operations. There are no data in the literature describing the feasibility, safety and efficacy of operative EUS in the treatment of common bile duct (CBD) obstruction, following a malignant or benign disease, performed completely under EUS guidance without fluoroscopic assistance.
  
  
  METHODS
  In this series we describe three cases of EUS treatment of CBD diseases performed without fluoroscopic assistance.
  
  
  RESULTS
  All the cases were treated by EUS without fluoroscopic assistance and no complications were encountered.
  
  
  CONCLUSIONS
  Operative EUS without fluoroscopy appears to be a feasible technique. Its major advantages could be to shorten the examination time and to enable biliary or pancreatic operative endoscopy in patients in whom fluoroscopy could be dangerous, such as pregnant women. The endoscopist should have a good training both in EUS and endoscopic retrograde cholangiopancreatography. Prospective, larger studies are needed to confirm our preliminary data.
authors.affiliation: Gastroenterology and Gastrointestinal Endoscopy Unit, San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Paolo Giorgio
authors.initials: PG
authors.lastname: Arcidiacono
authors.affiliation: Department of Gastrointestinal Endoscopy, San Paolo Universitary Hospital, Milan, Italy.
authors.forename: Benedetto
authors.initials: B
authors.lastname: Mangiavillano
authors.affiliation: Gastroenterology and Gastrointestinal Endoscopy Unit, San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Silvia
authors.initials: S
authors.lastname: Carrara
authors.affiliation: Gastroenterology and Gastrointestinal Endoscopy Unit, San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Maria Chiara
authors.initials: MC
authors.lastname: Petrone
authors.affiliation: Department of Gastrointestinal Endoscopy, San Paolo Universitary Hospital, Milan, Italy.
authors.forename: Tara
authors.initials: T
authors.lastname: Santoro
authors.affiliation: Gastroenterology and Gastrointestinal Endoscopy Unit, San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Pier Alberto
authors.initials: PA
authors.lastname: Testoni
keywords: ERCP; EUS; X-ray; biliary tree; common bile duct (CBD); endoscopic ultrasound; fluoroscopy