Endoscopic ultrasound-guided cholangiography and intraluminal needle puncture through a tight subhilar bile duct stricture for biliary stenting following failed ERCP

Abstract

Endoscopic therapy by endoscopic retrograde cholangiopancreatography (ERCP), stricture dilation, and sequential multiple stent placement is the standard treatment option for benign biliary strictures, and has favorable results [1]. Occasionally, tight biliary stricture can pose a technical challenge by not allowing the guide wire to pass. Recently, endoscopic ultrasound (EUS)-guided biliary access has been shown to be safe and successful in cases of failed ERCP due to inability to cannulate [2]. It is not known whether the EUS-guided rendezvous procedure also facilitates guide wire passage across difficult strictures. We report a case of post-cholecystectomy subhilar stricture in which ERCP-guided passage of the guide wire across the stricture was unsuccessful. Hence, EUS-guided cholangiography was carried out followed by intraluminal needle puncture of the stricture with a 18-gauge needle device to pass the guide wire, with completion of the ERCP and stenting.