EUS-guided drainage of bilomas: a new alternative?

Background: Bilomas have traditionally been treated by either percutaneous drainage or surgery. However, percutaneous drainage is associated with discomfort and infection, whereas surgery which is usually reserved for refractory cases, has high morbidity and mortality rates. Recently, endoscopic drainage of bilomas adjacent to the GI lumen has been reported in isolated reports. Objective: We analyzed our 4 years' experience with this innovative technique. Design: Patients with symptomatic bilomas were offered EUS-guided drainage and were followed up prospectively, for clinical and radiologic responses. Setting: Tertiary care center with long-standing experience in EUS-guided drainage. Patients: A total of 5 patients underwent EUS-guided transenteric drainage of symptomatic bilomas. Intervention: The technique included transenteric EUS-guided puncture, placement of a guidewire into the biloma, and creation of an enteral-biloma fistula with placement of a plastic endoprosthesis after balloon dilation. in 4 cases, the stents were removed at a mean of 6.8 +/- 4.3 weeks. in one patient with malignancy, the stent was left in place for palliation. Main Outcome Measurements: Efficacy and safety of EUS-guided drainage of bilomas. Results: EUS-guided transenteric biloma drainage was successfully performed in 5 patients without any significant morbidity. Bilorna resolution was confirmed in all 5 patients, and none of the 4 patients relapsed after stent removal (mean follow-up of 12.8 +/- 6.1 months). Conclusions: EUS-guided drainage of bilomas is technically feasible, appears safe, and provides an attractive alternative to percutancous or surgical drainage.