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.


M. KahalehMD 

Digestive Health Center Box 800708
University of Virginia Health System

VA 22908-0708

Fax: +1-434-924-0491

Email: mk5ke@virginia.edu