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Updated: Oct 26, 2025

Endoscopic Ultrasound-Guided Biliary Drainage: Endoscopic Ultrasound-Guided Hepaticogastrostomy in Malignant Biliary Obstruction
Published on: March 25, 2022
"White bile" as a result of a malignant bile obstruction
Sara Pérez Moyano1, César Arranz Solana2, Julio Guilarte López-Mañas2
1Medicina Interna, Hospital Comarcal de Baza, España.
Abstract:
An 87-year-old female was admitted for endoscopic retrograde cholangiopancreatography (ERCP) due to obstructive jaundice. On admission, total bilirubin was 15 mg/dl at the expense of direct bilirubin, GOT 356 U/l mg/dl, GPT 174 U/l, FA 2,358 U/l and GGT 1,089 U/l. The ERCP showed a prominent, irregular, non-cannulable papilla, so a fistulotomy was performed, emitting a clear, non-mucous fluid. Biliary localization was verified after inserting the guidewire. Cholangiography showed dilatation of the intra-extra hepatic bile duct (common bile duct 18-20 mm). An uncoated metal prosthesis was implanted and a biopsy was performed, confirming papillary adenocarcinoma.
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