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. 2018 May 16;10(5):99-108.
doi: 10.4253/wjge.v10.i5.99.

Different options of endosonography-guided biliary drainage after endoscopic retrograde cholangio-pancreatography failure

José Celso Ardengh  1 , César Vivian Lopes  2 , Rafael Kemp  1 , José Sebastião Dos Santos  1
Affiliations

Different options of endosonography-guided biliary drainage after endoscopic retrograde cholangio-pancreatography failure

José Celso Ardengh et al. World J Gastrointest Endosc. .

Abstract

Aim: To investigate the success rates of endosonography (EUS)-guided biliary drainage (EUS-BD) techniques after endoscopic retrograde cholangiopancreatography (ERCP) failure for management of biliary obstruction.

Methods: From Feb/2010 to Dec/2016, ERCP was performed in 3538 patients, 24 of whom (0.68%) suffered failure to cannulate the biliary tree. All of these patients were initially submitted to EUS-guided rendez-vous (EUS-RV) by means of a transhepatic approach. In case of failure, the next approach was an EUS-guided anterograde stent insertion (EUS-ASI) or an EUS-guided hepaticogastrostomy (EUS-HG). If a transhepatic approach was not possible or a guidewire could not be passed through the papilla, EUS-guided choledochoduodenostomy (EUS-CD) was performed.

Results: Patients were submitted to EUS-RV (7), EUS-ASI (5), EUS-HG (6), and EUS-CD (6). Success rates did not differ among the various EUS-BD techniques. Overall, technical and clinical success rates were 83.3% and 75%, respectively. Technical success for each technique was, 71.4%, 100%, 83.3%, and 83.3%, respectively (P = 0.81). Complications occurred in 3 (12.5%) patients. All of these cases were managed conservatively, but one patient died after rescue percutaneous transhepatic biliary drainage (PTBD).

Conclusion: The choice of a particular EUS-BD technique should be based on patient's anatomy and on whether the guidewire could be passed through the duodenal papilla.

Keywords: Cholestasis; Drainage; Endosonography; Interventional procedures; Jaundice; Neoplasms.

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Conflict of interest statement

Conflict-of-interest statement: No potential conflicts of interest relevant to this article were reported.

Figures

Figure 1
Figure 1
The systematic endosonography-guided biliary drainage approach for endoscopic retrograde cholangiopancreatography failure. PTBD: Percutaneous transhepatic biliary drainage; EUS-CD: Endosonography-guided choledochoduodenostomy; EUS-HG: Endosonography-guided hepaticogastrostomy; EUS-ASI: Endosonography-guided anterograde stent insertion; EUS-RV: Endosonography-guided rendez-vous.
Figure 2
Figure 2
Patient with acute pancreatitis after cholecystectomy and Billroth II gastrectomy. Endosonography (EUS)-guided rendez-vous technique. A: EUS image with dilation of the intrahepatic biliary duct; B: EUS-guided cholangiography; C: Insertion of the guidewire across the duodenal papilla and positioning in the duodenum; D: Capture of the guidewire with a frontal view endoscope; E: Balloon dilatation of the duodenal papilla; F: Insertion of a 10 Fr plastic stent.
Figure 3
Figure 3
Patient with duodenal stenosis due to a pancreatic carcinoma. A: Endosonography (EUS)-guided cholangiography; B: Insertion of the guidewire through the duodenal major papilla and positioning in the duodenum; C: Anterograde insertion of the self-expandable metallic stents (SEMS) through the gastric wall across the duodenal major papilla and its positioning in the duodenum; D: Deployment of the SEMS; E: Insertion of the duodenal SEMS. SEMS: Self-expandable metallic stents.
Figure 4
Figure 4
Endosonography-guided hepatogastrostomy. A: Endosonography (EUS) puncture of the dilated biliary intrahepatic duct; B: EUS-guided cholangiography; C and D: Deployment and positioning of the biliary self-expandable metallic stents (SEMS); E: Endoscopic view of the SEMS through the gastric wall.
Figure 5
Figure 5
Endosonography-guided choledochoduodenostomy. A: Endosonography (EUS) image of the pancreatic carcinoma; B: Puncture of the common bile duct through the duodenum with a 19 gauge aspiration needle; C: Insertion of the self-expandable metallic stents after balloon dilation of the fistula; D: EUS-guided cholangiography through the choledochoduodenostomy.
See this image and copyright information in PMC

References

    1. Carr-Locke DL. Overview of the role of ERCP in the management of diseases of the biliary tract and the pancreas. Gastrointest Endosc. 2002;56:S157–S160. - PubMed
    1. Fogel EL, Sherman S, Devereaux BM, Lehman GA. Therapeutic biliary endoscopy. Endoscopy. 2001;33:31–38. - PubMed
    1. Peng C, Nietert PJ, Cotton PB, Lackland DT, Romagnuolo J. Predicting native papilla biliary cannulation success using a multinational Endoscopic Retrograde Cholangiopancreatography (ERCP) Quality Network. BMC Gastroenterol. 2013;13:147. - PMC - PubMed
    1. Williams EJ, Ogollah R, Thomas P, Logan RF, Martin D, Wilkinson ML, Lombard M. What predicts failed cannulation and therapy at ERCP? Results of a large-scale multicenter analysis. Endoscopy. 2012;44:674–683. - PubMed
    1. Ferrucci JT Jr, Mueller PR, Harbin WP. Percutaneous transhepatic biliary drainage: technique, results, and applications. Radiology. 1980;135:1–13. - PubMed