External biliary-gastric fistula: a simple method for recycling bile.

External biliary drainage is often required to relieve bile duct obstruction. Most often this is a temporary situation and internal drainage is soon established by means of surgery or by transhepatic biliary stents placed through the obstruction into the duodenum. When internal drainage cannot be established and external biliary losses are prolonged, malabsorption, dehydration, and electrolyte imbalance may ensue. In this report we present two such cases in which an external biliary-gastric fistula was created by connecting the biliary drainage catheter to a percutaneous endoscopic gastrostomy. In both cases internal diversion was effectively achieved. We believe this technique warrants consideration in those patients otherwise committed to prolonged external biliary drainage.