cqvip:Background: This report describes a novel application of EUS guided cholangio graphy in which a transhepatic approach was used to alleviate perihilar and dist al biliary obstructions when this could not be accomplished at ERCP. Methods: EU S- guided transhepatic cholangiography was used to alleviate symptoms of biliar y obstruction in 6 patients. In 4 cases, after transgastric puncture of an intra hepatic branch of the obstructed bile duct with a 19- or a 22- gauge EUS need le, 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 per formed in 6 patients, with successful rendezvous ERCP and stent placement in 4, and transduodenal stent placement in another patient. Stent placement was unsucc essful in one patient, because of the inability to advance a guidewire into the common hepatic duct. There was no immediate complication of the procedures. Conc lusions: 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.
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