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Updated: Aug 23, 2026
Endoscopic Ultrasound-Guided Biliary Drainage: Endoscopic Ultrasound-Guided Hepaticogastrostomy in Malignant Biliary Obstruction
Published on: March 25, 2022
[Ultrasound-guided endoscopic drainage, without radiological examination, in patients with neoplastic biliary
G D De Palma1, A Puzziello, G Aprea
1Dipartimento di Chirurgia Generale e Tecnologie Avanzate, Settore Funzionale di Diagnostica e Terapia Endoscopica, Università degli Studi Federico II, Facoltà di Medicina e Chirurgia, Napoli, Italy. gdepalma@arrotino.it
Aim:
Endoscopic stent insertion has become the preferred method for palliation of malignant biliary obstruction. Currently, endoscopic stent placement involves the use of contrast media and radiological equipment to achieve direct opacification of the biliary duct systems, and to determine the location and the extension of biliary obstruction. This report proposes a new combination of ultrasonography and biliary endoscopy, with endoscopic stent placement entirely performed under US-guidance.
Methods:
US-guided stent placement was carried out in 8 patients. A guide-wire and a guiding-catheter were endoscopically introduced and identified, by US, the common bile duct across the stricture. Hydromer-coated polyurethane angled stents (10F) were finally inserted over the guide-wire/guiding-catheter by a pusher tube system.
Results:
Successful stent insertion was achieved in all patients. There were no complications. Successful drainage, with substantial reduction in bilirubin level, was achieved in all patients (14.2+/-9.5 vs 4.2+/-2.9 mg/dl at 1 week).
Conclusion:
Endoscopic stent placement performed under US-guidance, is safe and effective. Further studies in a larger series, including more proximal strictures are suggested.
