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Review
. 2019 Nov 28;8(Suppl 1):S67-S71.
doi: 10.4103/eus.eus_60_19. eCollection 2019 Nov.

EUS-guided biliary drainage for difficult cannulation

Keiichi Hatamaru  1 , Masayuki Kitano  1
Affiliations
Review

EUS-guided biliary drainage for difficult cannulation

Keiichi Hatamaru et al. Endosc Ultrasound. .

Abstract

EUS-guided biliary drainage (EUS-BD) has been recognized as a new alternative to failed ERCP. The alternatives for failed/impossible ERCP in cases of difficult and selective bile duct cannulation include percutaneous transhepatic BD (PTBD) with precut papillotomy. EUS-BD is reportedly more convenient than PTBD and more successful than precut papillotomy, suggesting that EUS-BD is the next step following failed/impossible ERCP.

Keywords: EUS-guided biliary drainage; percutaneous transhepatic biliary drainage; precut papillotomy technique.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
A case of choledocholithiasis, wherein EUS-rendezvous was performed without intrahepatic bile duct dilatation. (a) Puncture the extrahepatic bile duct using a 19G fine-needle aspiration needle under EUS guidance (white arrow). (b) Inject a contrast medium into the extrahepatic bile duct (white arrow) and then, confirm choledocholithiasis (white arrowhead). (c) Lead the guidewire successfully to the papilla side (white arrow) and advance it to the duodenum. (d) While retaining guidewire, remove the EUS scope and insert the ERCP scope to the duodenal papilla. Then, hold the soft parts of guidewire using a snare
Figure 2
Figure 2
A case of failed ERCP for carcinoma of the duodenal papilla. (a) Papillary orifice cannot be recognized due to carcinoma of the papilla of Vater. (b) Puncture the extrahepatic bile duct from the duodenal bulb (white arrow). (c) Followed by cholangiography, advances the guidewire into the hilar bile duct. Then, insert the stent delivery system (white arrow). (d) The stent is deployed completely
See this image and copyright information in PMC

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