Simultaneous bilateral reintervention using one-step endoscopic ultrasound-guided biliary drainage for severe acute cholangitis caused by malignant hilar biliary obstruction

Endoscopic retrograde cholangiopancreatography (ERCP) is a standard technique for endoscopic biliary drainage in malignant hilar biliary obstruction (MHBO). In cases of unresectable MHBO, the deployment of bilateral self-expandable metal stents (SEMSs) may be indicated [1] [2]. However, with the recent development of systemic chemotherapy [3] and local tumor treatment by endoscopic radiofrequency ablation, the frequency of reintervention for stent dysfunction may increase and reintervention after bilateral SEMS deployment may be challenging. If reintervention under ERCP guidance is needed, percutaneous transhepatic biliary drainage (PTBD) is considered. As with other biliary drainage techniques, endoscopic ultrasound (EUS)-guided hepaticogastrostomy (HGS) and hepaticoduodenostomy (HDS) can be considered bilateral reintervention techniques [4] [5].