When ERCP Fails: EUS-Guided Access to Biliary and Pancreatic Ducts

Area of Science:

• Gastroenterology
• Interventional Endoscopy
• Biliary and Pancreatic Diseases

Background:

• Pancreaticobiliary (PB) endotherapy is advancing with therapeutic endosonography.
• Endoscopic retrograde cholangiopancreatography (ERCP) is the standard for PB access, but faces challenges in altered anatomies.
• Enteroscopy-assisted ERCP and laparoscopy-assisted ERCP have limitations for PB access.

Purpose of the Study:

• To review the role of endoscopic ultrasound (EUS) in pancreaticobiliary interventions.
• To highlight EUS-guided biliary and pancreatic duct drainage (EUS-BPD) as an alternative when ERCP is unsuccessful.
• To discuss indications, techniques, and outcomes of EUS-BPD.

Main Methods:

• Review of current literature on EUS-BPD and ERCP for pancreaticobiliary access.
• Analysis of EUS-BPD as a salvage therapy for failed ERCP.
• Discussion of procedural advancements and equipment in EUS-BPD.

Main Results:

• EUS-BPD is emerging as a preferred alternative to ERCP failure.
• EUS-BPD demonstrates advantages over percutaneous drainage in feasibility, safety, and efficacy.
• Continuous improvement in dedicated equipment enhances EUS-BPD outcomes.

Conclusions:

• EUS-BPD is a valuable endoscopic ultrasound technique for pancreaticobiliary drainage when ERCP fails.
• EUS-BPD offers a viable and often superior alternative to other drainage methods.
• Ongoing technological advancements are further improving the safety and effectiveness of EUS-BPD.