A novel technique for treatment of intrahepatic biliary obstruction using an endobronchial ultrasound system

Biliary obstruction (BO) is one of the complications after hepatobiliary surgery decreasing patients' quality of life. Existing interventional methods, such as endoscopic retrograde biliary drainage, occasionally fail to treat this condition. This is the first report of treatment of BO using an endobronchial ultrasound (EBUS) system. A 65-year-old woman developed BO at the confluence of the bile duct of segment 3 of the liver (B3) and segment 2 (B2) after extended right hepatectomy for hepatocellular carcinoma. Percutaneous transhepatic biliary drainage (PTBD) was performed through B3, and its fistula was dilated up to the size of an 18-Fr PTBD silicone catheter. An EBUS endoscope was inserted through the dilated PTBD route. B2 was punctured through the EBUS endoscope inserted to B3 just before the obstruction with a needle for fine-needle aspiration biopsy. A guidewire was inserted to the common bile duct through the needle, and a 7.2-Fr PTBD catheter was placed over the guidewire. The inserted PTBD catheter was clamped, and internal biliary drainage was established. The catheter was patent for 24 months, and the patient had no episodes of jaundice or cholangitis. This technique using the EBUS system can be a treatment option for BO.