Benign distal biliary stricture due to severe acute pancreatitis successfully treated with endosonography-guided biliary drainage

We conducted endosonography-guided biliary drainage (ESBD) for a patient with a benign distal biliary stricture. The patient was a 37-year-old man who had undergone endoscopic retrograde cholangiopancreatography (ERCP) under the suspicion of a common bile duct stone. After the procedure, severe acute pancreatitis occurred, and the infected peripancreatic necrosis induced a duodenal stenosis with a distal biliary stricture. We performed ESBD to resolve the morbidity, because the duodenal stenosis precluded the transpapillary drainage and intrahepatic bile duct did not dilate widely enough to allow percutaneous transhepatic biliary drainage. As the peripancreatic abscess resolved with endoscopic and percutaneous drainage, all catheters and stents including ones inserted under ESBD were withdrawn. This case suggested that ESBD may become an alternative to the endoscopic biliary drainage for benign biliary strictures.