Biliary - EUS Guided Biliary Drainage
Comments: This patient has unresectable pancreatic cancer and obstructive jaundice. ERCP showed an infiltrating tumor in the papilla and cannulation was not successful despite a fairly aggressive precut sphincterotomy.
EUS is used to puncture the bile duct through the duodenal bulb, to pass a 0.025 Tracer wire (Wilson Cook) through the papilla. The wire repeatedly goes up the duct instead of down, but eventually is directed distally trough papilla. The wire is advanced far into duodenum, the EUS scope is removed, and ERCP used to grab the wire and cannulate bile duct.
A biliary Wallstent (Boston Scientific) is placed, and patient discharged after a few hours. We have had success with this EUS guided rendezvous technique in rare cases of ERCP duct access failure, as was reported in Gastrointestinal Endoscopy in 2004.
| Contributed by: |
Martin L. Freeman, M.D. Professor of Medicine Hennepin County Medical Center University of Minnesota |
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Citation: Freeman, ML (Feb 16 2006). Biliary - EUS Guided Biliary Drainage. The DAVE Project. Retrieved Sep, 6, 2010, from http://daveproject.org/viewfilms.cfm?film_id=315 Times viewed since Feb 2006: 8034 |
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