Endoscopic guided biliary drainage: how can we achieve efficient biliary drainage?

Area of Science:

• Gastroenterology
• Interventional Endoscopy
• Biliary Interventions

Background:

• Endoscopic retrograde cholangiopancreatography (ERCP) is the primary method for biliary drainage.
• ERCP success rates are high but can be limited by altered anatomy or duodenal obstruction.
• Alternative approaches carry significant morbidity and mortality risks.

Purpose of the Study:

• To review the indications and techniques of endoscopic ultrasound-guided biliary drainage (EUS-BD).
• To discuss the evolving role of EUS-BD in managing complex pancreatico-biliary disorders.
• To highlight the advantages and limitations of EUS-BD.

Main Methods:

• Review of current EUS-BD techniques and indications.
• Discussion of intrahepatic and extrahepatic approaches.
• Analysis of patient selection, equipment, and potential complications.

Main Results:

• EUS-BD is increasingly adopted globally for cases where ERCP is unsuccessful.
• Diverse EUS-BD techniques have been developed by advanced endoscopists.
• Standardization of indications and methods for EUS-BD is still evolving.

Conclusions:

• EUS-BD is a viable alternative for biliary drainage in challenging cases.
• Further standardization is needed to optimize EUS-BD procedures.
• EUS-BD expands endoscopic treatment options for pancreatico-biliary disorders.