EUS-guided biliary drainage for malignant hilar biliary obstruction: A concise review

Area of Science:

• Gastroenterology and Interventional Endoscopy
• Hepatobiliary Imaging and Intervention

Background:

• Distal biliary obstruction often necessitates biliary drainage, with ERCP as a primary modality.
• Malignant hilar biliary obstruction presents unique challenges, traditionally managed with percutaneous transhepatic biliary drainage or ERCP.
• Endoscopic ultrasound-guided biliary drainage (EUS-BD) is an emerging alternative in expert hands.

Purpose of the Study:

• To review the current evidence for EUS-BD in managing malignant hilar biliary obstruction.
• To discuss the various EUS-BD techniques applicable to hilar obstruction.
• To highlight the limitations and challenges associated with EUS-BD for hilar biliary obstruction.

Main Methods:

• Review of currently available evidence on EUS-BD for malignant hilar biliary obstruction.
• Discussion of specific EUS-BD techniques: hepaticogastrostomy, hepaticoduodenostomy, bridging stent placement, and combined approaches.
• Analysis of limitations and challenges in the application of EUS-BD.

Main Results:

• EUS-BD is an emerging option for distal and hilar biliary obstruction.
• Various EUS-BD routes exist for hilar obstruction, including hepaticogastrostomy and hepaticoduodenostomy.
• Evidence for EUS-BD in malignant hilar obstruction is growing, but challenges remain.

Conclusions:

• EUS-BD is a viable alternative for distal biliary obstruction and an emerging option for malignant hilar biliary obstruction.
• Specific EUS-BD techniques offer tailored approaches to hilar biliary drainage.
• Further research is needed to fully establish the role and optimize EUS-BD for malignant hilar biliary obstruction.