Balloon compression technique using an echoendoscopic balloon tip to prevent bile leakage in endoscopic ultrasound-guided choledochoduodenostomy

Endoscopic ultrasound-guided biliary drainage (EUS-BD) is an alternative treatment for patients with malignant biliary obstruction or those with failed endoscopic retrograde cholangiopancreatography (ERCP) [1] [2] [3] [4]. Endoscopic ultrasound-guided choledochoduodenostomy (EUS-CDS), a specific type of EUS-BD, can cause complications, such as bile peritonitis [5]. Previous studies have reported bile leakage in 2.8% of cases and peritonitis in 1.4% of EUS-CDS procedures [2]. In EUS-guided hepaticogastrostomy, a longer length of the liver parenchyma is associated with a reduced risk of bile leakage [3]. In contrast, EUS-CDS lacks surrounding organ support, potentially increasing the risk of peritonitis if bile leakage occurs ([Fig. 1]). We developed a novel technique using balloon compression at the fistula site with an echoendoscope balloon tip to prevent bile leakage-induced peritonitis ([Video 1]).