Endoscopic biliary stenting is the most common method of treating obstructive jaundice.
We present a new technique of biliary drainage using endoscopic ultrasound (EUS) and
EUS-guided puncture of the common bile duct (CBD). A 56-year-old man with obstructive
jaundice was referred for EUS and endoscopic retrograde cholangiopancreatography (ERCP)
because a computed tomography (CT) scan had shown a pancreatic mass in the head of
the pancreas and a dilated CBD. The patient was enrolled in a preoperative chemoradiotherapy
protocol and biliary stenting was required. Deep cannulation was not obtained even
after a precut and the procedure was stopped. Using a therapeutic EUS scope (FG 38X
Pentax), the CBD was punctured with a 5-F needle-knife under EUS guidance and a cholangiogram
was obtained. A 0.35-inch guide wire was introduced into the CBD. The EUS scope was
removed and a duodenoscope was introduced, allowing the placement through the duodenum
of a 10-F plastic stent. The CBD was drained properly. No complication occurred.
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M. Giovannini,M.D.
Endoscopy Unit
Paoli-Calmettes Institute
232 Bd Ste-Marguerite
13273 Marseille Cedex 9
France
Fax: + 33-4-91223650
eMail: hdjchir@marseille.fnclcc.fr