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Comprehensive review on EUS-guided biliary drainage.

Raffaele Salerno1, Sophia Elizabeth Campbell Davies2, Nicolò Mezzina1

  • 1Gastroenterology and Digestive Endoscopy Unit, ASST Fatebenefratelli Sacco - Department of Biochemical and Clinical Sciences "L. Sacco", University of Milan, Milano 20100, Italy.

World Journal of Gastrointestinal Endoscopy
|June 18, 2019
PubMed
Summary
This summary is machine-generated.

Endoscopic ultrasonography-guided biliary drainage offers an alternative when standard ERCP fails due to anatomical issues. This technique, including transmural and transpapillary approaches, requires skilled endoscopists and support teams.

Keywords:
EUSEndoscopic ultrasonography-guided antegrade stent placementEndoscopic ultrasonography-guided biliary drainageEndoscopic ultrasonography-guided choledochoduodenostomyEndoscopic ultrasonography-guided hepatogastric anastomosisEndoscopic ultrasonography-guided rendezvousEndoscopic ultrasonography-guided transgallbladderPercutaneous transhepatic biliary drainage

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Area of Science:

  • Gastroenterology
  • Interventional Endoscopy
  • Biliary Interventions

Background:

  • Endoscopic retrograde cholangiopancreatography (ERCP) is a primary method for biliary drainage but is not always feasible.
  • Anatomical alterations or difficult papilla access can limit ERCP success.
  • Percutaneous transhepatic biliary drainage (PTBD) is a traditional alternative, but it is invasive.

Purpose of the Study:

  • To evaluate endoscopic ultrasonography-guided biliary drainage (EUS-BD) as an alternative to PTBD when ERCP fails.
  • To describe different EUS-BD approaches, including intrahepatic and extrahepatic routes.
  • To discuss the role of novel stenting technologies in EUS-BD.

Main Methods:

  • Review of EUS-guided biliary drainage techniques, including rendez-vous transpapillary and transmural approaches.
  • Discussion of the application of self-expandable metal stents (SEMS) and lumen-apposing metal stents (LAMS).
  • Consideration of access site variations (intrahepatic vs. extrahepatic).

Main Results:

  • EUS-BD is a viable alternative to PTBD for biliary drainage when ERCP is unsuccessful.
  • Rendez-vous transpapillary drainage is effective when the duodenum is accessible but ERCP fails.
  • Transmural EUS-BD can be challenging and associated with adverse events.

Conclusions:

  • Endoscopic ultrasonography-guided biliary drainage provides a valuable alternative to PTBD in cases of ERCP failure.
  • The choice between transpapillary and transmural EUS-BD depends on anatomical factors and accessibility.
  • Successful EUS-BD necessitates experienced endoscopists with expertise in both ERCP and EUS, along with multidisciplinary support.