Endoscopic ultrasound-guided biliary drainage-current status and future perspectives

Area of Science:

• Gastroenterology
• Interventional Endoscopy
• Biliary Interventions

Background:

• Endoscopic retrograde cholangiopancreatography (ERCP) is standard for bile duct obstruction.
• ERCP failure occurs in specific anatomical challenges.
• Percutaneous biliary drainage (PTBD) is a rescue option with significant risks.

Purpose of the Study:

• To review the technical aspects of EUS-BD.
• To evaluate EUS-BD efficacy and safety compared to PTBD.
• To discuss future perspectives for EUS-BD.

Main Methods:

• Review of existing literature on EUS-BD techniques.
• Comparison of EUS-BD outcomes with PTBD.
• Analysis of EUS-BD advantages and disadvantages.

Main Results:

• EUS-BD demonstrates efficacy and safety, potentially replacing PTBD.
• Various EUS-BD techniques (transmural stenting, antegrade, rendezvous) exist.
• Challenges include lack of training, devices, and standardization.

Conclusions:

• EUS-BD is a promising alternative for ERCP failure.
• Personalized EUS-BD techniques can be employed.
• Developing training and standardization will improve EUS-BD acceptance and safety.