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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