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EUS-guided right hepatic bile duct drainage in complicated hilar stricture

Published:August 01, 2016DOI:https://doi.org/10.1016/j.gie.2016.07.056
      EUS-guided biliary drainage (EUS-BD) has been reported as a useful and safe salvage technique in cases of ERCP failure or inaccessible papilla. However, EUS-guided right hepatic bile duct drainage (EUS-RBD) remains challenging, although recent reports have described successful EUS-RBD with antegrade stenting or bypass stenting with conventional biliary metal stents. Recently we have developed a new single-pigtail plastic stent designed for EUS-BD. We describe 2 cases of EUS-RBD with use of the dedicated plastic stent. A 58-year-old man and a 68-year-old man each experienced malignant hilar biliary stricture resulting from lymph node metastasis of colon cancer and an unresectable hilar cholangiocarcinoma, respectively. After failed transpapillary drainage, EUS-RBD was performed. The right hepatic bile duct was punctured through the bulbus of the duodenum with a 19-gauge or a 22-gauge needle under EUS guidance, and a dedicated 7F plastic stent was placed into the right hepatic bile duct (Fig. 1; Video 1, available online at www.giejournal.org). After EUS-RBD, the obstructive jaundice and cholangitis improved immediately without any adverse events. In conclusion, EUS-RBD with a dedicated plastic stent appears to be feasible and useful in selected patients with a complicated hilar stricture.
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      Figure 1A, Advancement of a 22-gauge needle into the posterior segmental right hepatic bile duct under EUS guidance. B, Placement of a dedicated 7F plastic stent for EUS-guided biliary drainage into the right hepatic bile duct.
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