Original ArticleClinical EndoscopyInterventional EUS-guided cholangiography: evaluation of a technique in evolution
Section snippets
Methodology
All patients who presented with obstructive jaundice and who underwent IEUC after a failed ERCP during a 3-year study period were entered in this study. Failed ERCP was defined as failed cannulation or an inability to relieve symptomatic jaundice. A total of 3501 ERCPs were performed during the study period, of which 1519 required biliary decompression. Of these 1519 patients, 1365 successfully underwent conventional biliary drainage (90%), 126 required pre-cut techniques (8%), and the
Results
A total of 23 patients were included in this study, 12 women and 11 men. The mean age was 61.5 ± 11.7 years. All patients had successful EUS-assisted cholangiography with definition of the relevant anatomy.
Eighteen patients underwent intrahepatic cholangiography, with conversion to an extrahepatic intervention in 5 patients (27%). Of the 13 patients who underwent intrahepatic intervention, 11 had a stent placed across the major papilla. One patient had a cholangiogastric fistula created with
Discussion
Biliary obstruction is preferentially managed by ERCP.3 Failure of ERCP is related to tumor extension,21 prior surgery,6 or incomplete drainage.22 Alternatives after failed ERCP include percutaneous transhepatic drainage and surgery. Percutaneous transhepatic drainage has a complication rate of up to 32%, including fistula formation, cholangitis, peritonitis, empyema, hematoma, and liver abscesses.23, 24 Surgery offers long-term patency but is associated with increased morbidity and mortality.25
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Cited by (0)
Part of this work was presented as a poster at Digestive Disease Week, Chicago, Illinois, May 14-18, 2005. Gastrointest Endosc 2005;61:AB285.