Brief Article
Copyright ©2013 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. Aug 7, 2013; 19(29): 4758-4763
Published online Aug 7, 2013. doi: 10.3748/wjg.v19.i29.4758
A novel technique for endoscopic ultrasound-guided biliary drainage
Varayu Prachayakul, Pitulak Aswakul
Varayu Prachayakul, Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
Pitulak Aswakul, Liver and Digestive Institute, Samitivej Sukhumvit Hospital, Bangkok 10110, Thailand
Author contributions: Prachayakul V developed the concept; Prachayakul V and Aswakul P performed the data acquisition and wrote and revised the paper.
Correspondence to: Dr. Varayu Prachayakul, Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, 2 Prannok Road, Bangkok 10700, Thailand.
Telephone: +66-2-4121088   Fax: +66-2-4196101
Received: January 10, 2013
Revised: May 16, 2013
Accepted: June 1, 2013
Published online: August 7, 2013

AIM: To describe a successful endoscopic ultrasound (EUS)-guided biliary drainage technique with high success and low complication rates.

METHODS: The recorded data of consecutive patients who presented to Siriraj Gastrointestinal Endoscopy Center, Siriraj Hospital in Bangkok, Thailand for treatment of malignant obstructive jaundice but failed endoscopic retrograde cholangiopancreatography and underwent subsequent EUS-guided biliary drainage were retrospectively reviewed. The patients’ baseline characteristics, clinical manifestations, procedure details, and post-procedure follow-up data were recorded and analyzed. Clinical outcomes were assessed by physical exam and standard laboratory tests. Technical success of the procedure was defined as completion of the stent insertion. Clinical success was defined as improvement of the patient’s overall clinical manifestations, in terms of general well-being evidenced by physical examination, restoration of normal appetite, and adequate biliary drainage. Overall median survival time was calculated as the time from the procedure until the time of death, and survival analysis was performed by the Kaplan-Meier method. The Student’s t-test and the χ2 test were used to assess the significance of inter-group differences.

RESULTS: A total of 21 cases were enrolled, a single endoscopist performed all the procedures. The mean age was 62.8 years (range: 46-84 years). The sex distribution was almost equal, including 11 women and 10 men. Patients with failed papillary cannulation (33.3%), duodenal obstruction (42.9%), failed selective cannulation (19.0%), and surgical altered anatomy (4.8%) were considered candidates for EUS-guided biliary drainage. Six patients underwent EUS-guided choledochoduodenostomy and 15 underwent EUS-guided hepaticogastrostomy. The technique using non-cauterization and no balloon dilation was performed for all cases, employing the in-house manufactured tapered tip Teflon catheter to achieve the dilation. The technical success and clinical success rates of this technique were 95.2% and 90.5%, respectively. Complications included bile leakage and pneumoperitoneum, occurred at a rate of 9.5%. None of the patients died from the procedure. One patient presented with a biloma, a major complication that was successfully treated by another endoscopic procedure.

CONCLUSION: We present a highly effective EUS-guided biliary drainage technique that does not require cauterization or balloon dilation.

Keywords: Endoscopic ultrasound, Biliary drainage, Hepaticogastrostomy, Choledochoduodenostomy, Endoscopic ultrasound-guided

Core tip: A total of 21 patients who underwent endoscopic ultrasound (EUS)-guided biliary drainage following failure of endoscopic retrograde cholangiopancreatography were analyzed. The EUS-guided biliary drainage technique, which does not require cauterization or balloon dilation, was found to be effective and safe. The rates of technical and clinical success were 95.2% and 90.5%, respectively. Complications occurred at a relatively low rate (9.5%) and included bile leakage and pneumoperitoneum. No procedure related deaths occurred during the procedure, hospital recovery, or follow-up period. However, one patient developed the major complication of iatrogenic biloma due to stent mal-position, which was successfully resolved by another endoscopic procedure.