title: Endoscopic ultrasound-guided biliary drainage: Bilateral systems drainage via left duct approach.
abstract: Endoscopic ultrasound (EUS)-guided biliary drainage is accepted as a less invasive, alternative treatment for patients in whom endoscopic retrograde cholangiopancreatography has failed. Most patients with malignant hilar obstruction undergo EUS-guided hepaticogastrostomy. The authors present the case of a 77-year-old man with advanced hilar cholangiocarcinoma who had undergone a roux-en-Y hepaticojejunostomy several months prior. He developed progressive jaundice and a low-grade fever that persisted for one week. The enteroscopic-assisted endoscopic retrograde cholangiopancreatography failed, thus the patient was scheduled for EUS-guided biliary drainage. In order to obtain adequate drainage, both intrahepatic systems were drained. This report describes the technique used for bilateral drainage via a transgastric approach. Currently, only a few different techniques for EUS-guided right system drainage have been reported in the literature. This case demonstrates that bilateral EUS-guided biliary drainage is feasible and effective in patients with hilar cholangiocarcinoma, and thus can be used as an alternative to percutaneous biliary drainage.
authors.affiliation: Varayu Prachayakul, Siriraj GI Endoscopy Center, Division of Gastroenterology, Department of Internal Medicine, Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand.
authors.forename: Varayu
authors.initials: V
authors.lastname: Prachayakul
authors.affiliation: Varayu Prachayakul, Siriraj GI Endoscopy Center, Division of Gastroenterology, Department of Internal Medicine, Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand.
authors.forename: Pitulak
authors.initials: P
authors.lastname: Aswakul
mesh_terms: D000368:Aged; D001650:Bile Duct Neoplasms / Q000150:complications*; D004322:Drainage / Q000295:instrumentation / Q000379:methods*; D019160:Endosonography; D006801:Humans; D041781:Jaundice, Obstructive / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D018285:Klatskin Tumor / Q000150:complications*; D008297:Male; D008670:Metals; D011474:Prosthesis Design; D015607:Stents; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional / Q000379:methods*
chemical_list: D008670:Metals
keywords: Bilateral systems; Biliary drainage; Endoscopic ultrasound-guided; Transmural drainage