The role of two-step EUS-guided antegrade treatment as an option for bile duct stones in patients with surgically altered anatomy

Abstract

The treatment of bile duct stones in patients with surgically altered anatomy had been difficult for management until the balloon assisted endoscope (BAE) approach was introduced. Patients had been referred to either percutaneous transhepatic biliary drainage (PTBD) or surgical operation which were the gold standard, though they were invasive and indication was limited. For example, percutaneous drainage is relatively contraindicated in patients with significant ascites, obesity, and/or non-dilated bile duct. The procedure is also associated with skin infection, bile leakage, and drain care. Surgical approaches are more invasive and may not be feasible in severely ill patients with multiple comorbidities.

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