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Endoscopic Ultrasound-Guided Biliary Access and Drainage

  • Vinay Dhir
  • Irfan Sandozi
  • Amit Maydeo
Chapter
Part of the Clinical Gastroenterology book series (CG)

Abstract

Drainage of an obstructed biliary tree is an important part of the management of patients with obstructive jaundice. In addition to providing relief from the jaundice and infection, endoscopic biliary drainage improves the quality of life in such patients. These patients usually are managed with endoscopic retrograde cholangiopancreatography (ERCP), where the success rate of biliary cannulation is over 90%. Traditionally, these approaches have been percutaneous transhepatic biliary drainage (PTBD) or surgery. Surgery has a lower rate of recurrent biliary obstruction but is associated with prolonged hospitalization. These approaches have the disadvantage of being invasive and associated prolonged hospitalization. To circumvent these hurdles, in the last decade, endoscopic ultrasound (EUS) has been utilized to provide guidance to place stents endoscopically and provide biliary drainage internally into the gastrointestinal tract. EUS-guided biliary drainage (EUS-BD) has evolved as an additional method to provide the necessary relief of biliary obstruction in patients in whom ERCP has failed or is not possible. In this chapter, we discuss the various methods to gain access to the bile duct for efficient biliary decompression utilizing EUS.

Keywords

Endoscopic ultrasound Biliary drainage Cystotome Needle knife Rendezvous procedure Self-expandable metal stents 

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Copyright information

© Springer International Publishing AG 2018

Authors and Affiliations

  1. 1.Department of Gastroenterology, Baldota Institute of Digestive SciencesGlobal HospitalMumbaiIndia
  2. 2.Department of GastroenterologyMercy Hospital, Minnesota GastroenterologyMinneapolisUSA

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