title: EUS-guided gallbladder drainage for rescue treatment of malignant distal biliary obstruction after unsuccessful ERCP.
abstract: OBJECTIVE
  EUS-guided bile duct drainage (EUS-BD) is a well-recognized rescue biliary drainage method after unsuccessful ERCP. EUS-guided gallbladder drainage (EUS-GBD) was recently used to treat acute cholecystitis. The aim of this study was to assess the efficacy and safety of EUS-GBD for malignant biliary stricture-induced obstructive jaundice after unsuccessful ERCP as well as unsuccessful or impractical EUS-BD.
  
  
  METHODS
  Between January 2006 and October 2014, 12 patients with obstructive jaundice due to unresectable malignant distal biliary stricture underwent EUS-GBD after ERCP failed. EUS-GBD was performed under the guidance of EUS and fluoroscopy by puncturing the gallbladder with a needle, inserting a guidewire, dilating the puncture hole, and placing a stent. The technical and functional success rates, adverse events rate, overall patient survival time, and stent dysfunction rate during patient survival were measured.
  
  
  RESULTS
  The rates of technical success, functional success, adverse events, and stent dysfunction were 100%, 91.7%, 16.7%, and 8.3%, respectively. The median survival time after EUS-GBD was 105 days (range 15 - 236 days).
  
  
  CONCLUSIONS
  EUS-GBD is a possible alternative route for decompression of the biliary system when ERCP is unsuccessful.
authors.affiliation: Department of Gastroenterology and Hepatology, Kinki University School of Medicine, Osaka-sayama, Japan.
authors.forename: Hajime
authors.initials: H
authors.lastname: Imai
authors.affiliation: Department of Gastroenterology and Hepatology, Kinki University School of Medicine, Osaka-sayama, Japan.
authors.forename: Masayuki
authors.initials: M
authors.lastname: Kitano
authors.affiliation: Department of Gastroenterology and Hepatology, Kinki University School of Medicine, Osaka-sayama, Japan.
authors.forename: Shunsuke
authors.initials: S
authors.lastname: Omoto
authors.affiliation: Department of Gastroenterology and Hepatology, Kinki University School of Medicine, Osaka-sayama, Japan.
authors.forename: Kumpei
authors.initials: K
authors.lastname: Kadosaka
authors.affiliation: Department of Gastroenterology and Hepatology, Kinki University School of Medicine, Osaka-sayama, Japan.
authors.forename: Ken
authors.initials: K
authors.lastname: Kamata
authors.affiliation: Department of Gastroenterology and Hepatology, Kinki University School of Medicine, Osaka-sayama, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Miyata
authors.affiliation: Department of Gastroenterology and Hepatology, Kinki University School of Medicine, Osaka-sayama, Japan.
authors.forename: Kentaro
authors.initials: K
authors.lastname: Yamao
authors.affiliation: Department of Gastroenterology and Hepatology, Kinki University School of Medicine, Osaka-sayama, Japan.
authors.forename: Hiroki
authors.initials: H
authors.lastname: Sakamoto
authors.affiliation: Department of Gastroenterology and Hepatology, Kinki University School of Medicine, Osaka-sayama, Japan.
authors.forename: Yogesh
authors.initials: Y
authors.lastname: Harwani
authors.affiliation: Department of Gastroenterology and Hepatology, Kinki University School of Medicine, Osaka-sayama, Japan.
authors.forename: Masatoshi
authors.initials: M
authors.lastname: Kudo
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001650:Bile Duct Neoplasms / Q000150:complications; D002760:Cholangiopancreatography, Endoscopic Retrograde; D002767:Cholecystostomy / Q000379:methods*; D002779:Cholestasis / Q000209:etiology / Q000601:surgery*; D004322:Drainage / Q000379:methods; D019160:Endosonography / Q000379:methods; D005260:Female; D005704:Gallbladder / Q000601:surgery*; D006801:Humans; D041781:Jaundice, Obstructive / Q000209:etiology / Q000601:surgery*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000150:complications; D012189:Retrospective Studies; D025321:Surgery, Computer-Assisted; D017211:Treatment Failure