Endoscopy 2011; 43 - A66
DOI: 10.1055/s-0031-1292137

Interventional EUS as an alternative to endoscopic biliary decompression through the duodenal papilla is feasible and safe

Tsutsumi Koichiro 1, Kawamoto Hirofumi 1, Noma Kazuhiro 1, Sonoyama Takayuki 1, Fujii Masakuni 1, Kato Hironari 1, Kurihara Naoko 1, Okada Hiroyuki 1, Yamamoto Kazuhide 1
  • 1Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan

Background and aim: EUS-guided biliary drainage (EUS-BD) has been developed as an alternative drainage procedure in patients with obstructive jaundice when endoscopic biliary drainage (EBD) failed. In addition, EUS-guided gallbladder drainage (EUS-GBD) has been employed as a new procedure which replaces percutaneous transhepatic gallbladder drainage in patients with cholecystitis. We evaluated the feasibility and safety of these procedures.

Patients & methods: From November 2006 to June 2010, EUS-BD was performed on 19 patients with obstructive jaundice, when transpapillary access of the bile duct was impossible. Under EUS guidance, puncture with 19-gauge needle was done from duodenum to extrahepatic bile duct or from stomach to intrahepatic bile duct. After dilation of the puncture route by biliary dilation catheters, a 7Fr stent was mainly placed. EUS-GBD was performed on 2 patients with recurrent cholecystitis after biliary metallic stent deployment which involved cystic duct. The distended gallbladder was punctured with a Zimmon needle knife from the stomach or duodenum under EUS guidance. After dilation of the puncture route, two double-pigtail stents were placed.

Results: EUS-BD was technically successful in all patients (100%); choledochoduodenostomy (EUS-CDS) in 15 of 15, hepaticogastorostomy (EUS-HGS) in 3 of 3 and anterograde drainage across biliary stricture (EUS-AD) in 1 of 1. A self-expandable metallic stent was placed in 3 patients who underwent EUS-HGS and 1 who underwent EUS-AD, while a plastic stent was placed in the other patients. Following successful EUS-BD, biliary decompression was achieved in all patients. The median patency period of the stent were 121 days (12–213). Complications (n=3: 16%) were pneumoperitoneum (n=1; EUS-CDS) and bile leakage (n=2: EUS-HGS). All patients recovered from these morbidities conservatively. EUS-GBD was successful in all 2 patients. No recurrence of cholecystitis was observed (141 and 150 days, respectively). No complications occurred after EUS-GBD.

Conclusion: It is suggested that the interventional EUS of the biliary tract may become an alternative to EBD when it failed. However, dedicated devices are needed for reliable procedures.