Related Experiment Video
Updated: May 9, 2026
Endoscopic Ultrasound-Guided Biliary Drainage: Endoscopic Ultrasound-Guided Hepaticogastrostomy in Malignant Biliary Obstruction
Published on: March 25, 2022
EUS-guided biliary drainage by using a standardized approach for malignant biliary obstruction: rendezvous versus
Mouen A Khashab1, Ali Kord Valeshabad, Rani Modayil
1Department of Medicine and Division of Gastroenterology and Hepatology, The Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.
Background:
EUS-guided biliary drainage (EGBD) can be performed via direct transluminal or rendezvous techniques. It is unknown how both techniques compare in terms of efficacy and adverse events.
Objective:
To describe outcomes of EGBD performed by using a standardized approach and compare outcomes of rendezvous and transluminal techniques.
Design:
Retrospective analysis of prospectively collected data.
Setting:
Two tertiary-care centers.
Patients:
Consecutive jaundiced patients with distal malignant biliary obstruction who underwent EGBD after failed ERCP between July 2006 and December 2012 were included.
Intervention:
EGBD by using a standardized algorithm.
Main Outcome Measurements:
Technical success, clinical success, and adverse events.
Results:
During the study period, 35 patients underwent EGBD (rendezvous n = 13, transluminal n = 20). Technical success was achieved in 33 patients (94%), and clinical success was attained in 32 of 33 patients (97.0%). The mean postprocedure bilirubin level was 1.38 mg/dL in the rendezvous group and 1.33 mg/dL in the transluminal group (P = .88). Similarly, length of hospital stay was not different between groups (P = .23). There was no significant difference in adverse event rate between rendezvous and transluminal groups (15.4% vs 10%; P = .64). Long-term outcomes were comparable between groups, with 1 stent migration in the rendezvous group at 62 days and 1 stent occlusion in the transluminal group at 42 days after EGBD.
Limitations:
Retrospective analysis, small number of patients, and selection bias.
Conclusion:
EGBD is safe and effective when the described standardized approach is used. Stent occlusion is not common during long-term follow-up. Both rendezvous and direct transluminal techniques seem to be equally effective and safe. The latter approach is a reasonable alternative to rendezvous EGBD.
