Interventionelle Endoskopische Ultraschall-Cholangiografie: Langzeitergebnisse einer neuen Alternative zur perkutanen Cholangiografie

Abstract

BACKGROUND AND STUDY AIMS: Endoscopic retro-grade cholangiography (ERC) with stenting is the procedure of choice for biliary decompression in patients with obstructive jaundice. In cases where biliary access cannot be achieved, interventional endoscopic ultrasound-guided cholangiography (IEUC) has become an alternative to percutaneous transhepatic cholangiography (PTC). PATIENTS AND METHODS: We report on 5 years of experience in patients who underwent IEUC after -failed endoscopic retrograde cholangiopancreatography (ERCP). Endoscopic ultrasound-guided access to the targeted biliary duct was attempted with one of two approaches: transgastric-transhepatic (intrahepatic) or transenteric-transcholedochal (extrahepatic). A stent was then advanced over the wire and into the biliary tree. RESULTS: A total of 49 patients underwent IEUC: 35 had biliary obstruction due to malignancy and 14 had a benign etiology. The overall success rate of IEUC was 84 % (41 / 49), with an overall complication rate of 16 %. Of the 35 patients who underwent the intrahepatic approach, 23 had a stent placed across the major papilla, one had a stent placed intra-ductally in the common bile duct, and three patients underwent placement of a gastrohepatic stent. Resolution of obstruction was achieved in 29 patients, with a success rate of 83 %. In all, 14 patients underwent an extrahepatic approach. In 8 / 14 (57 %), stent placement across the major papilla was achieved. A transenteric stent was placed in four patients. Biliary decompression was achieved in 12 / 14 cases (86 %). Based on intention-to-treat analysis, the intrahepatic approach achieved success in 29 of 40 cases (73 %), and the extrahepatic approach was successful in seven of nine cases (78 %). There were no procedure-related deaths. CONCLUSION: IEUC offers a feasible alternative to PTC in patients with obstructive jaundice in whom ERC has failed.