Original Contribution
The American Journal of Gastroenterology (2005) 100, 1743–1747; doi:10.1111/j.1572-0241.2005.41806.x
Endoscopic Ultrasound Guided Therapy of Benign and Malignant Biliary Obstruction: A Case Series
Andreas Püspök MD1, Friedrich Lomoschitz MD2, Clemens Dejaco MD1, Michael Hejna MD3, Thomas Sautner MD4 and Alfred Gangl MD1
- 1Department of Internal Medicine IV, Division of Gastroenterology, Medical University Vienna, Austria
- 2Department of Radiology, Medical University Vienna, Austria
- 3Department of Internal Medicine I, Division of Oncology, Medical University Vienna, Austria
- 4Department of Surgery, Medical University Vienna, Austria
Correspondence: Andreas Püspök, M.D., Department of Internal Medicine IV, Division of Gastroenterology, Medical University Vienna, Währingergürtel 18–20, A-1090 Vienna, Austria
Received 11 November 2004; Revised 0000; Accepted 6 February 2005.
Abstract
OBJECTIVES:
Endoscopic retrograde cholangiography is an established method for treatment of common bile duct stones as well as for palliation of patients with malignant pancreaticobiliary strictures. It may be unsuccessful in the presence of a complex peripapillary diverticulum, prior surgery, obstructing tumor, papillary stenosis, or impacted stones. Percutaneous transhepatic biliary drainage and surgery are alternative methods with a higher morbidity and mortality in these cases. Recently, endoscopic ultrasound (EUS) guided biliary stent placement has been described in patients with malignant biliary obstruction. We describe our experience with this method that was also used for the treatment of cholangiolithiasis for the first time.
METHODS:
The EUS guided transduodenal puncture of the common bile duct with stent placement was performed in 5 patients. In 2 of these patients, the stents were removed after several weeks and common bile duct stones were extracted. In another patient with gastrectomy, the left intrahepatic bile duct was punctured transjejunally and a metal stent was introduced transhepatically to bridge a distal common bile duct stenosis.
RESULTS:
Biliary decompression was successful in all 6 patients. No immediate complications occurred. One patient developed a subacute phlegmonous cholecystitis.
CONCLUSIONS:
Interventional EUS guided biliary drainage is a new technique that allows drainage of the biliary system in benign and malignant diseases when the bile duct is inaccessible by conventional ERCP.
