Endoscopic ultrasound-guided drainage of the biliary tree in malignant obstruction

Abstract

Endoscopic retrograde cholangiopancreatography (ERCP) with stenosis stenting is the procedure of choice for treatment of malignant biliary obstruction. It has a low failure rate (< 5%-10% in cases of normal anatomy). The traditional alternative is radiological percutaneous drainage with a variable and non-negligible burden of adverse events. Interventional endoscopic ultrasound offers real-time imaging of the bilio-pancreatic district with the possibility of accessing the main biliary duct and the left hepatic duct from the duodenum or stomach. Consequently, endoscopic ultrasound-guided biliary drainage, including the rendezvous technique, choledochoduodenostomy, and/or hepatico-gastro or antegrade stenting, has become a realistic option that offers advantages of a faster and cost-saving procedure since it can be performed immediately after ERCP, thus avoiding repeated sessions and prolonged hospital stays. We describe a case of malignant obstruction of the common bile duct that was drained by creation of choledocho-duodenal anastomosis under ultrasound-guided endoscopy.