Endoscopy 2009; 41(6): 532-538
DOI: 10.1055/s-0029-1214712
Original article

© Georg Thieme Verlag KG Stuttgart · New York

Interventional endoscopic ultrasound-guided cholangiography: long-term experience of an emerging alternative to percutaneous transhepatic cholangiography

J.  Maranki1 , A.  J.  Hernandez1 , B.  Arslan2 , A.  A.  Jaffan2 , J.  F.  Angle2 , V.  M.  Shami1 , M.  Kahaleh1
  • 1Digestive Health Center of Excellence, University of Virginia Health System, Charlottesville, Virginia, USA
  • 2Department of Radiology, University of Virginia Health System, Charlottesville, Virginia, USA
Further Information

Publication History

submitted 10 August 2008

accepted after revision 16 March 2009

Publication Date:
16 June 2009 (online)

Background and study aims: Endoscopic retrograde cholangiography (ERC) with stenting is the procedure of choice for biliary decompression in patients with obstructive jaundice. In cases where biliary access cannot be achieved, interventional endoscopic ultrasound-guided cholangiography (IEUC) has become an alternative to percutaneous transhepatic cholangiography (PTC).

Patients and methods: We report on 5 years of experience in patients who underwent IEUC after failed endoscopic retrograde cholangiopancreatography (ERCP). Endoscopic ultrasound-guided access to the targeted biliary duct was attempted with one of two approaches: transgastric–transhepatic (intrahepatic) or transenteric–transcholedochal (extrahepatic). A stent was then advanced over the wire and into the biliary tree.

Results: A total of 49 patients underwent IEUC: 35 had biliary obstruction due to malignancy and 14 had a benign etiology. The overall success rate of IEUC was 84 % (41 / 49), with an overall complication rate of 16 %. Of the 35 patients who underwent the intrahepatic approach, 23 had a stent placed across the major papilla, one had a stent placed intraductally in the common bile duct, and three patients underwent placement of a gastrohepatic stent. Resolution of obstruction was achieved in 29 patients, with a success rate of 83 %. In all, 14 patients underwent an extrahepatic approach. In 8 / 14 (57 %), stent placement across the major papilla was achieved. A transenteric stent was placed in four patients. Biliary decompression was achieved in 12 / 14 cases (86 %). Based on intention-to-treat analysis, the intrahepatic approach achieved success in 29 of 40 cases (73 %), and the extrahepatic approach was successful in seven of nine cases (78 %). There were no procedure-related deaths.

Conclusion: IEUC offers a feasible alternative to PTC in patients with obstructive jaundice in whom ERC has failed.

References

M. Kahaleh, MD 

Digestive Health Center Box 800708
University of Virginia Health System

Charlottesville
VA 22908-0708
USA

Fax: +1-434-924-0491

Email: mk5ke@virginia.edu