Advertisement

Clinical Journal of Gastroenterology

, Volume 5, Issue 3, pp 195–198 | Cite as

A novel technique for treatment of intrahepatic biliary obstruction using an endobronchial ultrasound system

  • Akira ChikamotoEmail author
  • Osamu Nakahara
  • Shinya Abe
  • Katsunori Imai
  • Hidetoshi Nitta
  • Hiromitsu Hayashi
  • Yoshiaki Ikuta
  • Koichi Doi
  • Takatoshi Ishiko
  • Hiroshi Takamori
  • Toru Beppu
  • Hideo Baba
Case Report
  • 100 Downloads

Abstract

Biliary obstruction (BO) is one of the complications after hepatobiliary surgery decreasing patients’ quality of life. Existing interventional methods, such as endoscopic retrograde biliary drainage, occasionally fail to treat this condition. This is the first report of treatment of BO using an endobronchial ultrasound (EBUS) system. A 65-year-old woman developed BO at the confluence of the bile duct of segment 3 of the liver (B3) and segment 2 (B2) after extended right hepatectomy for hepatocellular carcinoma. Percutaneous transhepatic biliary drainage (PTBD) was performed through B3, and its fistula was dilated up to the size of an 18-Fr PTBD silicone catheter. An EBUS endoscope was inserted through the dilated PTBD route. B2 was punctured through the EBUS endoscope inserted to B3 just before the obstruction with a needle for fine-needle aspiration biopsy. A guidewire was inserted to the common bile duct through the needle, and a 7.2-Fr PTBD catheter was placed over the guidewire. The inserted PTBD catheter was clamped, and internal biliary drainage was established. The catheter was patent for 24 months, and the patient had no episodes of jaundice or cholangitis. This technique using the EBUS system can be a treatment option for BO.

Keywords

Biliary obstruction PTBD EBUS system 

Notes

Conflict of interest

None.

Supplementary material

Supplementary material 1 (MOV 15088 kb)

References

  1. 1.
    Giovannini M, Moutardier V, Pesenti C, Bories E, Lelong B, Delpero JR. Endoscopic ultrasound-guided bilioduodenal anastomosis: a new technique for biliary drainage. Endoscopy. 2001;33:898–900.PubMedCrossRefGoogle Scholar
  2. 2.
    Bories E, Pesenti C, Caillol F, Lopes C, Giovannini M. Transgastric endoscopic ultrasonography-guided biliary drainage: results of a pilot study. Endoscopy. 2007;39:287–91.PubMedCrossRefGoogle Scholar
  3. 3.
    Will U, Meyer F, Schmitt W, Dollhopf M. Endoscopic ultrasound-guided transesophageal cholangiodrainage and consecutive endoscopic transhepatic Wallstent insertion into a jejunal stenosis. Scand J Gastroenterol. 2007;42:412–5.PubMedCrossRefGoogle Scholar
  4. 4.
    Park do H, Song TJ, Eum J, Moon SH, Lee SS, Seo DW, Lee SK, Kim MH: EUS-guided hepaticogastrostomy with a fully covered metal stent as the biliary diversion technique for an occluded biliary metal stent after a failed ERCP (with videos). Gastrointest Endosc. 2010;71:413–9.Google Scholar
  5. 5.
    Takao S, Matsuo Y, Shinchi H, Nakajima S, Aikou T, Iseji T, Yamanouchi E. Magnetic compression anastomosis for benign obstruction of the common bile duct. Endoscopy. 2001;33:988–90.PubMedCrossRefGoogle Scholar
  6. 6.
    Hurter T, Hanrath P. Endobronchial sonography: feasibility and preliminary results. Thorax. 1992;47:565–7.PubMedCrossRefGoogle Scholar

Copyright information

© Springer 2012

Authors and Affiliations

  • Akira Chikamoto
    • 1
    Email author
  • Osamu Nakahara
    • 1
  • Shinya Abe
    • 1
  • Katsunori Imai
    • 1
  • Hidetoshi Nitta
    • 1
  • Hiromitsu Hayashi
    • 1
  • Yoshiaki Ikuta
    • 1
  • Koichi Doi
    • 1
  • Takatoshi Ishiko
    • 1
  • Hiroshi Takamori
    • 1
  • Toru Beppu
    • 1
  • Hideo Baba
    • 1
  1. 1.Department of Gastroenterological SurgeryKumamoto UniversityKumamotoJapan

Personalised recommendations