EUS-guided transhepatic cholangiography: Report of 6 cases

Michel Kahaleh, Pin Wang, Vanessa M. Shami, Jeffrey Tokar, Paul Yeaton

Research output: Contribution to journalArticlepeer-review

77 Scopus citations


Background: This report describes a novel application of EUS-guided cholangiography in which a transhepatic approach was used to alleviate perihilar and distal biliary obstructions when this could not be accomplished at ERCP. Methods: EUS-guided transhepatic cholangiography was used to alleviate symptoms of biliary obstruction in 6 patients. In 4 cases, after transgastric puncture of an intrahepatic branch of the obstructed bile duct with a 19- or a 22-gauge EUS needle, a guidewire was advanced antegrade across both the biliary stricture and the papilla. Subsequently, a rendezvous procedure was performed, allowing ERCP and stent placement. Observations: EUS-guided transhepatic cholangiography was performed in 6 patients, with successful rendezvous ERCP and stent placement in 4, and transduodenal stent placement in another patient. Stent placement was unsuccessful in one patient, because of the inability to advance a guidewire into the common hepatic duct. There was no immediate complication of the procedures. Conclusions: EUS-guided transhepatic cholangiography can be used to access and to drain bile ducts that are obstructed by proximal, as well as distal lesions when ERCP is unsuccessful.

Original languageEnglish (US)
Pages (from-to)307-313
Number of pages7
JournalGastrointestinal Endoscopy
Issue number2
StatePublished - Feb 2005
Externally publishedYes

All Science Journal Classification (ASJC) codes

  • Radiology Nuclear Medicine and imaging
  • Gastroenterology


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