Interventional EUS: Difficult pancreaticobiliary access

Introduction

Endoscopic biliary stenting is the most common method to treat obstructive jaundice. But in 3 -12 % of cases, selective cannulation of the major papilla failed and surgery or percutaneous biliary drainage is required. But percutaneous drainage needed dilated intrahepatic biliary ducts and the rate of complications reach 20 % of cases including peritoneal bleeding. A new technique of biliary drainage using EUS and EUS guided puncture of the bile duct (common bile duct or left hepatic duct) is now possible.

Using EUS guidance and dedicated accessories it’s now possible to create bilio or pancreatico-digestive anastomosis.

References

• 1 Burmester E, Niehaus J, Leineweber T, Huetteroth T. EUS-cholangio-drainage of the bile duct: report of 4 cases.  Gastrointest Endosc. 2003 Feb;  57 (2) 246-251
• 2 Giovannini M, Dotti M, Bories E, Moutardier V, Pesenti C, Danisi C, Delpero J R. Hepaticogastrostomy by echo-endoscopy as a palliative treatment in a patient with metastatic biliary obstruction.  Endoscopy. 2003 Dec;  35 (12) 1076-1078
• 3 Giovannini M, Pesenti C h, Rolland A L, Mouardier V, Delpero J R. Endoscopic ultrasound guided bilioduodenal anastomosis: a new technique for biliary drainage.  Endoscopy. 2001;  33 898-900
• 4 Mallery S, Matlock J, Freeman M L. EUS-guided rendezvous drainage of obstructed biliary and pancreatic ducts: Report of 6 cases.  Gastrointest Endosc. 2004 Jan;  59 (1) 100-107
• 5 Francois E, Kahaleh M, Giovannini M, Matos C, Dviere J. EUS-guided pancreaticogastrostomy.  Gastrointest Endosc. 2002 Jul;  56 (1) 128-123