Endoscopic ultrasound-guided bilioduodenal anastomosis: A new technique for biliary drainage

Endoscopic biliary stenting is the most common method of treating obstructi ve jaundice. We present a new technique of biliary drainage using endoscopi c 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 endosco pic retrograde cholangiopancreatography (ERCP) because a computed tomograph y (CT) scan bad shown a pancreatic mass in the head of the pancreas and a d ilated CBD. The patient was enrolled in a preoperative chemoradiotherapy pr otocol 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 i ntroduced, allowing the placement through the duodenum of a 10-F plastic st ent. The CBD was drained properly. No complication occurred.