Combined percutaneous-ERCP approaches have been reported in selected instances. If the experience gained with EUS-guided anastomoses in the setting of palliation could be transferred to POBT, a minimally invasive treatment without the need of external drains might be feasible. Over a 6yr period 5 consecutive

patients with POBT were managed according to the two staged endoscopic treatment Ponatinib protocol detailed below. POBT were located at the hilum in 3 postcholecystectomy patients and in the CBD in another two (post-OLT: mid-CBD; post-duodenal resection: distal CBD). Patients with POBT who met inclusion criteria: a) Failed retrograde guidewire access to duct above the transection; b) Upstream dilatation visible under EUS; c) Patient consent Anatomic, procedural and clinical data were prospectively recorded & retrospectively reviewed. Stage 1: At ERCP: transection and inability to access proximal duct were confirmed. EUS-guided transluminal anastomosis (HG: hepaticogastrostomy or CD: choledochoduodenostomy) were performed using covered biliary metal stents. Stage 2: Interventions through the EUS-anastomoses aiming at antegrade guidewire passage were performed under fluoroscopy and/or cholangioscopy. Transluminal cholangioscopy was performed with a 5-mm outer

diameter transnasal gastroscope through FC-biliary stents or through MK 1775 mature fistulas after stent removal. If recanalization was successful, bilateral or single stent insertion were performed not at rendezvous ERCP and the patient entered a program of periodic stent replacement. Stage 1 was successful in all 5 cases without complications resulting in restoration of biliary drainage. Stage 2 succeeded in 80%, with one failed recanalization in a post-OLT patient who underwent surgical repair. There were two mild cholangitis. A number of interventions were performed through transluminal EUS-anastomoses 2-12 weeks after stage 1. Transluminal FC-biliary stents were easily removed resulting in mature fistulas. After restoration of biliary

continuity (wheter by endoscopic or surgical means) all fistulas closed-down. This approach warrants further evaluation. It provides internal biliary drainage and allows successful recanalization of 80% of cases, avoiding the need for complex surgery. “
“The usefulness of magnetic compression anastomosis (MCA) for choledochocholedochostomy had been reported in patients with normal anatomy or after liver transplantation. Herein, we describe the first report on the successful MCA for choledochocholedochostomy in a patient with Billroth II gastrectomy. In this case, obstructive jaundice was present due to postoperative hilar biliary obstruction. Although PTBD in posterior segmental branch was performed, negotiation to distal bile duct using a guidewire was impossible. Initially, we placed a 16-Fr PTBD tube to dilate the tract.