Interventional endoscopic ultrasound-guided cholangiography: Long-term experience of an emerging alternative to percutaneous transhepatic cholangiography

J. Maranki, A. J. Hernandez, B. Arslan, A. A. Jaffan, J. F. Angle, V. M. Shami, M. Kahaleh

Research output: Contribution to journalArticle

110 Citations (Scopus)

Abstract

Background and study aims: Endoscopic retrograde cholangiography (ERC) with stenting is the procedure of choice for biliary decompression in patients with obstructive jaundice. In cases where biliary access cannot be achieved, interventional endoscopic ultrasound-guided cholangiography (IEUC) has become an alternative to percutaneous transhepatic cholangiography (PTC). Patients and methods: We report on 5 years ofexperience in patients who underwent IEUC after failed endoscopic retrograde cholangiopancreatography(ERCP). Endoscopic ultrasound-guided access to the targeted biliary duct was attempted with one of two approaches: transgastric-transhepatic (intrahepatic) or transenteric- transcholedochal (extrahepatic). A stent was then advanced over the wire and into the biliary tree. Results: A total of 49 patients underwent IEUC: 35 had biliary obstruction due to malignancy and 14 had a benign etiology. The overall success rate of IEUC was 84% (41 / 49), with an overall complication rate of 16%. Of the 35 patients who underwent the intrahepatic approach, 23 had a stent placed across the major papilla, one had a stent placed intraductally in the common bile duct, and three patients underwent placement of a gastrohepatic stent. Resolution of obstruction was achieved in 29 patients, with a success rate of 83%. In all, 14 patients underwent an extrahepatic approach. In 8/14 (57 %), stent placement across the major papilla was achieved. A transenteric stent was placed in four patients. Biliary decompression was achieved in 12/14 cases (86 %). Based on intention-to-treat analysis, the intrahepatic approach achieved success in 29 of 40 cases(73 %), and the extrahepatic approach was successful in seven of nine cases (78 %). There were no procedure-related deaths. Conclusion: IEUC offers a feasible alternative to PTC in patients with obstructive jaundice in whom ERC has failed.

Original languageEnglish (US)
Pages (from-to)532-538
Number of pages7
JournalEndoscopy
Volume41
Issue number6
DOIs
StatePublished - Dec 1 2009

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Interventional Ultrasonography
Cholangiography
Stents
Obstructive Jaundice
Decompression
Intention to Treat Analysis
Endoscopic Retrograde Cholangiopancreatography
Common Bile Duct
Biliary Tract

All Science Journal Classification (ASJC) codes

  • Gastroenterology

Cite this

Maranki, J. ; Hernandez, A. J. ; Arslan, B. ; Jaffan, A. A. ; Angle, J. F. ; Shami, V. M. ; Kahaleh, M. / Interventional endoscopic ultrasound-guided cholangiography : Long-term experience of an emerging alternative to percutaneous transhepatic cholangiography. In: Endoscopy. 2009 ; Vol. 41, No. 6. pp. 532-538.
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title = "Interventional endoscopic ultrasound-guided cholangiography: Long-term experience of an emerging alternative to percutaneous transhepatic cholangiography",
abstract = "Background and study aims: Endoscopic retrograde cholangiography (ERC) with stenting is the procedure of choice for biliary decompression in patients with obstructive jaundice. In cases where biliary access cannot be achieved, interventional endoscopic ultrasound-guided cholangiography (IEUC) has become an alternative to percutaneous transhepatic cholangiography (PTC). Patients and methods: We report on 5 years ofexperience in patients who underwent IEUC after failed endoscopic retrograde cholangiopancreatography(ERCP). Endoscopic ultrasound-guided access to the targeted biliary duct was attempted with one of two approaches: transgastric-transhepatic (intrahepatic) or transenteric- transcholedochal (extrahepatic). A stent was then advanced over the wire and into the biliary tree. Results: A total of 49 patients underwent IEUC: 35 had biliary obstruction due to malignancy and 14 had a benign etiology. The overall success rate of IEUC was 84{\%} (41 / 49), with an overall complication rate of 16{\%}. Of the 35 patients who underwent the intrahepatic approach, 23 had a stent placed across the major papilla, one had a stent placed intraductally in the common bile duct, and three patients underwent placement of a gastrohepatic stent. Resolution of obstruction was achieved in 29 patients, with a success rate of 83{\%}. In all, 14 patients underwent an extrahepatic approach. In 8/14 (57 {\%}), stent placement across the major papilla was achieved. A transenteric stent was placed in four patients. Biliary decompression was achieved in 12/14 cases (86 {\%}). Based on intention-to-treat analysis, the intrahepatic approach achieved success in 29 of 40 cases(73 {\%}), and the extrahepatic approach was successful in seven of nine cases (78 {\%}). There were no procedure-related deaths. Conclusion: IEUC offers a feasible alternative to PTC in patients with obstructive jaundice in whom ERC has failed.",
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Interventional endoscopic ultrasound-guided cholangiography : Long-term experience of an emerging alternative to percutaneous transhepatic cholangiography. / Maranki, J.; Hernandez, A. J.; Arslan, B.; Jaffan, A. A.; Angle, J. F.; Shami, V. M.; Kahaleh, M.

In: Endoscopy, Vol. 41, No. 6, 01.12.2009, p. 532-538.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Interventional endoscopic ultrasound-guided cholangiography

T2 - Long-term experience of an emerging alternative to percutaneous transhepatic cholangiography

AU - Maranki, J.

AU - Hernandez, A. J.

AU - Arslan, B.

AU - Jaffan, A. A.

AU - Angle, J. F.

AU - Shami, V. M.

AU - Kahaleh, M.

PY - 2009/12/1

Y1 - 2009/12/1

N2 - Background and study aims: Endoscopic retrograde cholangiography (ERC) with stenting is the procedure of choice for biliary decompression in patients with obstructive jaundice. In cases where biliary access cannot be achieved, interventional endoscopic ultrasound-guided cholangiography (IEUC) has become an alternative to percutaneous transhepatic cholangiography (PTC). Patients and methods: We report on 5 years ofexperience in patients who underwent IEUC after failed endoscopic retrograde cholangiopancreatography(ERCP). Endoscopic ultrasound-guided access to the targeted biliary duct was attempted with one of two approaches: transgastric-transhepatic (intrahepatic) or transenteric- transcholedochal (extrahepatic). A stent was then advanced over the wire and into the biliary tree. Results: A total of 49 patients underwent IEUC: 35 had biliary obstruction due to malignancy and 14 had a benign etiology. The overall success rate of IEUC was 84% (41 / 49), with an overall complication rate of 16%. Of the 35 patients who underwent the intrahepatic approach, 23 had a stent placed across the major papilla, one had a stent placed intraductally in the common bile duct, and three patients underwent placement of a gastrohepatic stent. Resolution of obstruction was achieved in 29 patients, with a success rate of 83%. In all, 14 patients underwent an extrahepatic approach. In 8/14 (57 %), stent placement across the major papilla was achieved. A transenteric stent was placed in four patients. Biliary decompression was achieved in 12/14 cases (86 %). Based on intention-to-treat analysis, the intrahepatic approach achieved success in 29 of 40 cases(73 %), and the extrahepatic approach was successful in seven of nine cases (78 %). There were no procedure-related deaths. Conclusion: IEUC offers a feasible alternative to PTC in patients with obstructive jaundice in whom ERC has failed.

AB - Background and study aims: Endoscopic retrograde cholangiography (ERC) with stenting is the procedure of choice for biliary decompression in patients with obstructive jaundice. In cases where biliary access cannot be achieved, interventional endoscopic ultrasound-guided cholangiography (IEUC) has become an alternative to percutaneous transhepatic cholangiography (PTC). Patients and methods: We report on 5 years ofexperience in patients who underwent IEUC after failed endoscopic retrograde cholangiopancreatography(ERCP). Endoscopic ultrasound-guided access to the targeted biliary duct was attempted with one of two approaches: transgastric-transhepatic (intrahepatic) or transenteric- transcholedochal (extrahepatic). A stent was then advanced over the wire and into the biliary tree. Results: A total of 49 patients underwent IEUC: 35 had biliary obstruction due to malignancy and 14 had a benign etiology. The overall success rate of IEUC was 84% (41 / 49), with an overall complication rate of 16%. Of the 35 patients who underwent the intrahepatic approach, 23 had a stent placed across the major papilla, one had a stent placed intraductally in the common bile duct, and three patients underwent placement of a gastrohepatic stent. Resolution of obstruction was achieved in 29 patients, with a success rate of 83%. In all, 14 patients underwent an extrahepatic approach. In 8/14 (57 %), stent placement across the major papilla was achieved. A transenteric stent was placed in four patients. Biliary decompression was achieved in 12/14 cases (86 %). Based on intention-to-treat analysis, the intrahepatic approach achieved success in 29 of 40 cases(73 %), and the extrahepatic approach was successful in seven of nine cases (78 %). There were no procedure-related deaths. Conclusion: IEUC offers a feasible alternative to PTC in patients with obstructive jaundice in whom ERC has failed.

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