Korean J Gastroenterol.  2017 Mar;69(3):164-171. 10.4166/kjg.2017.69.3.164.

Endoscopic Ultrasound-guided Biliary Drainage

• Nam HS
• Kang DH

• KMID: 2383409
• DOI: http://doi.org/10.4166/kjg.2017.69.3.164

Abstract

The therapeutic role of endoscopic ultrasound (EUS) has continued to evolve in recent years. EUS-guided biliary drainage (EUS-BD) can be performed as an effective alternative to percutaneous drainage or surgical options when conventional Endoscopic retrograde cholangiopancreatography fails or is not possible. Depending on the access and exit routes of the stent, multiple approaches to EUS-BD have been proposed. Each patient should receive an individualized approach based on the patient's condition, anatomy, and endoscopist's experience, with an appropriate backup prepared. In high-volume centers, the cumulative success rate has been reported to be over 90%. However, the reported overall complication rate remains relatively high at 10-30%. Further studies are necessary to better understand the long-term results and standardize EUS-BD, including appropriate indications and optimal approach.

Keyword

Endoscopic ultrasonography; Drainage; Cholangiopancreatography, Endoscopic retrograde; Biliary tract

MeSH Terms

Biliary Tract
Cholangiopancreatography, Endoscopic Retrograde
Drainage*
Endosonography
Humans
Stents
Ultrasonography

Figure

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  Fig. 1. Endoscopic ultrasound-guided rendezvous procedure. (A) Cholangiogram revealing a dilated bile duct after common bile duct puncture from the duodenal bulb. (B) A guidewire passed anterograde through the needle across the obstruction and into the duodenum. (C) Withdrawal and remove the endoscopic ultrasound. (D) Stent catheter placed into the bile duct using the duodenoscope. (E, F) Advancement of the stent delivery system across the obstruction and deployment of a metal stent across the obstruction.

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  Fig. 2. Endoscopic ultrasound-guided choledochoduodenostomy. (A) Puncture of the common bile duct under endoscopic ultrasound. (B) Cholangiogram revealing a dilated bile duct after the needle puncture from the duodenal bulb. (C) Deployment of a metal stent via fistula tract between the bile duct and the duodenal bulb. (D) Endoscopic view of the deployed metal stent.

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  Fig. 3. Endoscopic ultrasound-guided hepaticogastrostomy. (A) Color flow Doppler of the left liver before puncture. (B) Puncture of the left hepatic duct under endoscopic ultrasound. (C) Fluoroscopic view of puncture of the left hepatic duct by ultrasonography with contrast injection. (D) Deployment of a metal stent across the obstruction. (E) Endoscopic view of the deployed metal stent.

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  Fig. 4. Endoscopic ultrasound-guided antegrade procedure. (A) Cholangiogram revealing a dilated intrahepatic bile duct after the needle puncture from the stomach. (B, C) A guidwire placed into the duodenum via the stenosis and dilation. (D) Antegradely inserted metal stent which is placed into the duodenum via papilla.

Reference

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