Endoscopic ultrasound-guided biliary drainage

Area of Science:

• Gastroenterology
• Endoscopic Procedures
• Biliary Interventions

Background:

• Endoscopic retrograde cholangiopancreatography (ERCP) is the standard for biliary drainage.
• Complex biliary obstructions, particularly hilar or distal lesions, can pose challenges for ERCP.
• Alternative minimally invasive techniques are needed for refractory cases.

Purpose of the Study:

• To comprehensively review published literature on endoscopic ultrasound (EUS)-guided biliary drainage.
• To evaluate the efficacy and indications of different EUS-guided biliary drainage techniques.

Main Methods:

• Systematic review of published articles, including case reports, case series, and previous reviews.
• Focus on studies detailing EUS-guided hepaticogastrostomy, coledochoduodenostomy, and choledoantrostomy.

Main Results:

• EUS-guided biliary drainage encompasses hepaticogastrostomy (for hilar obstruction) and coledochoduodenostomy/choledoantrostomy (for distal lesions).
• These advanced echo-endoscopy procedures are recommended after unsuccessful ERCP.
• Multidisciplinary decision-making and patient consultation are crucial for procedure indication.

Conclusions:

• EUS-guided biliary drainage techniques are feasible and effective when performed by experienced biliopancreatic endoscopists.
• These advanced echo-endoscopy procedures require rigorous protocols, especially in academic and training settings.