EUS guided biliary drainage
https://doi.org/10.1148/rg.2020190158 Definition : An extra-anatomic drainage route between the gastrointestinal (GI) tract and the biliary system is created with a covered metallic stent or plastic stent. Indications : Conventional transpapillary BD is unsuccessful. Unsuccessful placement of a percutaneous biliary stent H/o severe acute pancreatitis by transpapillary BD Types : HGS - H epaticogastrostomy. HJS - Hepaticojejunostomy (after gastrectomy), CDS - Choledochoduodenostomy. HDS - Hepaticoduodenostomy. GBD - EUS gallbladder drainage. Checklist : Type of biliary obstruction. Collateral vessels in the puncture route. Ascites. Volume of the liver segment. Distribution of an intrahepatic tumor. GI tract patency. Bismuth classification Bismuth classification for biliary stricture in the hilar region : Type I - confluence of the hepatic duct is preserved. Type II - confluence of the hepatic duct is invaded. Type III - confluence of the second branch of the unilateral hepatic du