Endoscopic Ultrasound-Guided Bilioduodenal Anastomosis: A New Technique for Biliary Drainage

TLDR

Obstructive jaundice is commonly treated with endoscopic biliary stenting, and the patient required stenting as part of preoperative chemoradiotherapy. The authors introduce a novel biliary drainage technique using endoscopic ultrasound–guided puncture of the common bile duct. In a 56‑year‑old man with a pancreatic head mass and dilated CBD, the team performed an EUS‑guided puncture of the CBD with a 5‑F needle‑knife, obtained a cholangiogram, placed a 0.35‑inch guidewire, and then deployed a 10‑F plastic stent via duodenoscope. The initial ERCP failed to achieve deep cannulation, but the EUS‑guided approach successfully drained the CBD without any complications.

Abstract

Endoscopic biliary stenting is the most common method of treating obstructive jaundice. We present a new technique of biliary drainage using endoscopic ultrasound (EUS) and EUS-guided puncture of the common bile duct (CBD). A 56-year-old man with obstructive jaundice was referred for EUS and endoscopic retrograde cholangiopancreatography (ERCP) because a computed tomography (CT) scan had shown a pancreatic mass in the head of the pancreas and a dilated CBD. The patient was enrolled in a preoperative chemoradiotherapy protocol and biliary stenting was required. Deep cannulation was not obtained even after a precut and the procedure was stopped. Using a therapeutic EUS scope (FG 38X Pentax), the CBD was punctured with a 5-F needle-knife under EUS guidance and a cholangiogram was obtained. A 0.35-inch guide wire was introduced into the CBD. The EUS scope was removed and a duodenoscope was introduced, allowing the placement through the duodenum of a 10-F plastic stent. The CBD was drained properly. No complication occurred.