EUS-cholangio-drainage of the bile duct: report of 4 cases

Background: Endoscopic retrograde cholangiography with stent insertion is an established procedure for palliation of patients with malignant pancreaticobiliary strictures. In some patients, however, placement of a stent by means of a duodenoscope is not possible. Percutaneous transhepatic biliary drainage is an alternative method that has a complication rate of up to 15%. Four cases of successful EUS-guided-cholangio-drainage are presented in which the major papilla could not be cannulated at endoscopic retrograde cholangiography. Methods: For puncture of the intrahepatic or extrahepatic bile duct, a modification of the one-step technique for the drainage of pancreatic pseudocysts was used. Results: Stent insertion was successful in 3 of the 4 patients. In these 3 patients cholestasis resolved promptly. Conclusions: EUS-guided cholangio-drainage is a potential alternative to percutaneous transhepatic biliary drainage and endoscopic retrograde cholangiography in the therapy of malignant pancreaticobiliary strictures.