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Armellini et al. Mini-invasive Surg 2018;2:23 Mini-invasive Surgery
DOI: 10.20517/2574-1225.2018.07

Case Report Open Access

Endoscopic ultrasound-guided drainage of the
biliary tree in malignant obstruction

Elia Armellini, Fabrizio Mazza, Marco Ballarè, Giulio Donato, Marco Orsello, Pietro Occhipinti

Gastroenterology Department, “Maggiore della Carità” Hospital, Novara 28100, Italy.

Correspondence to: Dr. Elia Armellini, Gastroenterology Department, “Maggiore della Carità” Hospital, largo Mazzini 18,
Novara 28100, Italy. E-mail: elia.armellini@maggioreosp.novara.it

How to cite this article: Armellini E, Mazza F, Ballarè M, Donato G, Orsello M, Occhipinti P. Endoscopic ultrasound-guided
drainage of the biliary tree in malignant obstruction. Mini-invasive Surg 2018;2:23.
http://dx.doi.org/10.20517/2574-1225.2018.07

Received: 30 Jan 2018 First Decision: 4 Jun 2018 Revised: 22 Jun 2018 Accepted: 25 Jul 2018 Published: 10 Aug 2018
Science Editor: Fernando A. Alvarez Copy Editor: Jun-Yao Li Production Editor: Huan-Liang Wu

Abstract
Endoscopic retrograde cholangiopancreatography (ERCP) with stenosis stenting is the procedure of choice for
treatment of malignant biliary obstruction. It has a low failure rate (< 5%-10% in cases of normal anatomy). The
traditional alternative is radiological percutaneous drainage with a variable and non-negligible burden of adverse events.
Interventional endoscopic ultrasound offers real-time imaging of the bilio-pancreatic district with the possibility of
accessing the main biliary duct and the left hepatic duct from the duodenum or stomach. Consequently, endoscopic
ultrasound-guided biliary drainage, including the rendezvous technique, choledochoduodenostomy, and/or hepatico-
gastro or antegrade stenting, has become a realistic option that offers advantages of a faster and cost-saving procedure
since it can be performed immediately after ERCP, thus avoiding repeated sessions and prolonged hospital stays. We
describe a case of malignant obstruction of the common bile duct that was drained by creation of choledocho-duodenal
anastomosis under ultrasound-guided endoscopy.

Keywords: Endoscopic ultrasound, biliary drainage, pancreatic cancer, ultrasound-guided biliary drainagex

INTRODUCTION
Endoscopic retrograde cholangiopancreatography (ERCP) with stenosis stenting is the procedure of choice
for treatment of malignant biliary obstruction. Even though it has a low failure rate, < 5%-10% in cases of
normal anatomy. ERCP can be unsuccessful in cases of gastric outlet obstruction or unidentifiable papilla
such as duodenal stenosis, post-surgical anatomy, duodenal diverticula, and/or tumor infiltration of the
papilla. When ERCP fails, the traditional alternative is percutaneous biliary drainage (PTBD), which has

© The Author(s) 2018. Open Access This article is licensed under a Creative Commons Attribution 4.0
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