Interventional EUS-guided cholangiography: evaluation of a technique in evolution

Area of Science:

• Gastroenterology
• Interventional Endoscopy
• Biliary Interventions

Background:

• Endoscopic retrograde cholangiopancreatography (ERCP) is a primary treatment for biliary obstruction.
• Percutaneous transhepatic cholangiography (PTC) is an alternative when ERCP fails.
• Interventional EUS-guided cholangiography (IEUC) is emerging as a viable option for complex biliary interventions.

Purpose of the Study:

• To review the technique and outcomes of interventional EUS-guided cholangiography (IEUC).
• To evaluate the efficacy and safety of IEUC as an alternative to PTC after failed ERCP.

Main Methods:

• A 3-year review of patients undergoing IEUC following failed ERCP.
• EUS was used to access the biliary system, followed by guidewire advancement for drainage.
• Approaches included transgastric-transhepatic (intrahepatic) and transenteric-transcholedochal (extrahepatic).

Main Results:

• IEUC was successful in 23 of 28 eligible patients.
• Therapeutic benefit was achieved in 21 patients, including successful stent deployment (18) and choledochoenteric fistula formation (3).
• Complications were infrequent, including bile leak, pneumoperitoneum, and minor bleeding.

Conclusions:

• IEUC is an effective and safe alternative for biliary decompression when ERCP is unsuccessful.
• The intrahepatic approach for IEUC appears safer than the extrahepatic approach.
• IEUC is a valuable tool in the management of complex biliary obstructions.