الفهرس 
Introduction
Endoscopic UltrasonographyOnly 14 pages are availabe for public view
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Abstract
EUS-guided biliary drainage is an alternative treatment for biliary obstruction after failed ERCP. Our prospective study emerged to assess the success and complication rates of various EUS-guided biliary procedures in patients with distal biliary obstruction between September 2018 and August 2019 A total of 32 patients with biliary obstruction were enrolled in the study, 23 were males and 9 were females; mean age was 64.47 ± 9.453 years, ranged from 40 to 79 years. The distal biliary obstruction was malignant in 30 cases and benign (stone) in 2 cases. The reasons for failed ERCP were duodenal stenosis (n=11), surgical bypass (previous gastrectomy) (n=2), biliary cannulation failure associated with periampullary tumour infiltration (n=16) and altered position of the papilla (n=3). The causes of duodenal stenosis were pancreatic cancer (n= 6), ampullary carcinoma (n=3), duodenal cancer (n=1) and cicatrized duodenal ulcer (n=1). CDS was performed in 15 patients while HGS in 13 patients and antegrade techniques in 4 patients. Both technical and clinical success were 100% in all cases with decrease of the bilirubin level after the procedure. Adverse events occurred in 6 patients, 2 of them in CDS group (one patient had bile leakage and one developed sepsis) and 4 patients in HGS group (one patient had stent migration, one had sepsis, one developed bile leakage and one had abdominal pain), but no adverse events were noticed in the antegrade group. A 7 Fr nasobiliary catheter was placed through the metallic stent in patients with sepsis, with return of body temperature to normal level within 48 hours and decrease of WBCs count during follow up. An uncovered metallic stent was placed through the covered stent in one patient to avoid stent migration. Repositioning of migrated stent to the intrahepatic bile duct was done in one patient.