Endoscopic Ultrasound-Guided Bilioduodenal Anastomosis: A New Technique for Biliary Drainage

Abstract

Endoscopic biliary stenting is the most common method of treating obstructive jaundice. We present a new technique of biliary drainage using endoscopic ultrasound (EUS) and EUS-guided puncture of the common bile duct (CBD). A 56-year-old man with obstructive jaundice was referred for EUS and endoscopic retrograde cholangiopancreatography (ERCP) because a computed tomography (CT) scan had shown a pancreatic mass in the head of the pancreas and a dilated CBD. The patient was enrolled in a preoperative chemoradiotherapy protocol and biliary stenting was required. Deep cannulation was not obtained even after a precut and the procedure was stopped. Using a therapeutic EUS scope (FG 38X Pentax), the CBD was punctured with a 5-F needle-knife under EUS guidance and a cholangiogram was obtained. A 0.35-inch guide wire was introduced into the CBD. The EUS scope was removed and a duodenoscope was introduced, allowing the placement through the duodenum of a 10-F plastic stent. The CBD was drained properly. No complication occurred.

One-step Placement of a Fully-covered Metal Stent in Endosonography-guided Biliary Drainage for Malignant Biliary Obstruction

“…Since the first report on ESBD by Giovannini et al (2) in 2001, there have been an increasing number of reports on this technique. Thus far, ESBD has been employed mainly in cases with difficult EBD.…”

“…ESBD is performed via the gastrointestinal tract to the extra/intra-hepatic bile duct through the intra-abdominal space. Therefore, plastic stent placement via the puncture site to the target biliary duct is performed in the first session to prevent bile leakage in many reports (2)(3)(4)(5)(6)(7)(8)(9)(10)(11). Only a few case series undergoing ESBD with deployment of a covered self-expandable metal stent (SEMS) in a one-step fashion across the puncture site have been reported because there is a risk of migration of the deployed covered SEMS (5,7,8).…”

Endoscopic ultrasound guided fistulization between left intrahepatic duct and jejunum in a patient with Roux-en-Y anastomosis and jaundice

“…In the last decade a new endoscopic salvage procedure has been described which allows biliary and pancreatic transmural access guided by endoscopic ultrasound (EUS) in patients in whom ERCP is not feasible (2,3). Hereafter we will refer to this technique as endosonography-guided cholangio-pancreatography (ESCP).…”

Decompression of Malignant Biliary Obstruction After Failed ERCP: To EUSBD and Not to PTBD?

“…Recently, endoscopic ultrasound-guided biliary drainage (EUSBD) has been used as an alternative for patients with failed ERCP. Since it was first described in 2001 by Giovannini et al [6], many reports have been published focusing on its indications, technique modifications, and efficacy. There is, however, a paucity of literature regarding comparison of EUSBD and PTBD.…”

“…There is, however, a paucity of literature regarding comparison of EUSBD and PTBD. EUSBD may have advantages over PTBD including avoidance of vascular injury, lack of interference by ascites, and internal drainage within a single session [3,4,6,7]. Moreover, EUSBD can be successfully performed even in patients who have undergone total gastrectomy or partial gastrectomy with a Billroth II reconstruction.…”