EUS-guided biliary approch for benign biliary diseases

Aims EUS-guided biliary approach (EUS-BA) mostly aims for drainage and is used for malignant biliary obstructions as a means of palliation in patients with altered gastrointestinal anatomy, gastric outlet obstruction and failure of cannulation or reaching over the level of stricture by ERCP. Recently, the EUS-BA emerged as a therapeutic modality in patients with benign conditions for whom ERCP fails or is not feasible due to the same reasons mentioned above, and this is mostly done for biliary stones and/or biliary strictures.Its application under urgent conditions can be lifesaving.

Methods Patients who underwent therapeutic endosonography were examined retrospectively and fourteen eligible patients were included (five hepatico-gastrostomies, one hepatico-esophagostomy, two choledocho-duodenostomy, four cholecysto-gastrotomy and two cholecysto-duodenostomy). While we put 10x80 mm fully covered biliary metallic stents (FC-SEMS) for hepatico-gastrostomies and hepatico-esophagostomy, we put 10x60 mm FC-SEMS for choledocho-duodenostomies and cholecysto-gastrostomy/duodenostomy. Although following procedures can be done in the same session, it may migrate inside (into the liver) or, less frequently, outside (to the stomach) in the following procedures. Because of this, we defer further management to a second session, usually 3-to-4 weeks later.

Results The median age of the patients was 53 years and, ten (71%) of the patients were male. Seven patients experinced complications during the follow-up: in five (including two deaths) cholangitis occurred and all of them were taken under control with antibiotic treatment. Two patients admitted to hospital with upper gastrointestinal bleeding; one received one unit of transfusion and the other wasn’t required transfusion and gastroscopy demonstrated hemorrhagic gastritis. At least 24 months of the follow-up, 2 patients died; one had previously been operated on for colon carcinoma and had a permanent stoma due to several comorbid conditions at the age of 86. The other had metastatic colon carcinoma and died after a course over three years.

Conclusions EUS-BA for managing biliary duct stones is effective and safe. However, especially in patients with severely dilated common bile or hepatic duct (over 20 mm), recurrence of stones and/or cholangitis is frequent.

Publication History

Article published online:
27 March 2025