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Related Concept Videos

Endoscopic Procedures V: ERCP01:26

Endoscopic Procedures V: ERCP

694
Endoscopic Retrograde Cholangiopancreatography (ERCP) is a diagnostic procedure that combines endoscopy and fluoroscopy to diagnose and treat conditions related to the bile ducts, pancreatic ducts, and gallbladder. This procedure is beneficial for identifying and addressing blockages, gallstones, strictures, and tumors within the biliary or pancreatic systems. ERCP is both diagnostic and therapeutic, offering the ability to visualize and treat identified problems in one session.
Patient...
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Ultrasound II: Endoscopic Ultrasound and FibroScan01:25

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Endoscopic Ultrasound (EUS) and FibroScan are valuable diagnostic tools in gastroenterology and hepatology, each with specific applications and techniques.
Endoscopic Ultrasound (EUS):
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Urinary Tract Calculi VI: Surgical Management01:25

Urinary Tract Calculi VI: Surgical Management

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Procedures for Kidney StonesMedical intervention is necessary when kidney stones or renal calculi are too large to pass spontaneously (typically greater than 5 millimeters) when stones are accompanied by symptomatic infection (such as fever or pyelonephritis), when they impair kidney function, or when they cause persistent symptoms like severe pain, nausea, or urinary retention. Additionally, patients with only one kidney or those who cannot be treated with medical management also require...
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Urologic Endoscopic Procedure: Cystoscopic Examination01:28

Urologic Endoscopic Procedure: Cystoscopic Examination

208
Meaning of Cystoscopic Examination:Cystoscopy is an essential diagnostic tool in urology that is used to assess the structure and function of the genitourinary system. It provides a direct view of the urethra, bladder, and, in some cases, the ureteral openings. This procedure helps detect structural abnormalities, infections, cancers, and blockages in the urinary tract. There are two types of cystoscopy:Flexible cystoscopy is commonly performed in outpatient settings due to its less invasive...
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Related Experiment Video

Updated: Aug 15, 2025

Endoscopic Ultrasound-Guided Biliary Drainage: Endoscopic Ultrasound-Guided Hepaticogastrostomy in Malignant Biliary Obstruction
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Endoscopic ultrasound guided biliary interventions.

Giuseppe Dell'Anna1, Takeshi Ogura2, Giuseppe Vanella1

  • 1Pancreatobiliary Endoscopy and Endosonography Division, Pancreas Translational & Clinical Research Center, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy.

Best Practice & Research. Clinical Gastroenterology
|December 28, 2022
PubMed
Summary

Endoscopic Ultrasound-Guided Biliary Drainage (EUS-BD) offers a safe and effective alternative when Endoscopic Retrograde Cholangiopancreatography (ERCP) fails. This advanced endoscopic technique provides superior outcomes compared to traditional percutaneous methods for biliary drainage.

Keywords:
Biliary drainageBiliary obstructionEUS-Guided antegrade stenting (EUS AS)EUS-Guided biliary drainageEUS-Guided choledocho-duodenostomy (EUS CDS)EUS-Guided hepatico-gastrostomy (EUS-HGS)EUS-Guided rendezvous (EUS RV)Endoscopic retrograde cholangiopancreatography

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Area of Science:

  • Gastroenterology and Hepatology
  • Interventional Endoscopy
  • Biliary Interventions

Background:

  • Endoscopic Retrograde Cholangiopancreatography (ERCP) has limitations, with failure rates of 5-10% in complex cases like papillary infiltration or altered anatomy.
  • Percutaneous Transhepatic Biliary Drainage (PTBD) is a traditional rescue therapy but is associated with significant adverse events and reduced quality of life.
  • The advancement of Endoscopic Ultrasound (EUS) has transformed it into a therapeutic modality for biliary interventions.

Purpose of the Study:

  • To review the technical aspects and clinical evidence for Endoscopic Ultrasound-Guided Biliary Drainage (EUS-BD) as an alternative to ERCP and PTBD.
  • To evaluate the efficacy and safety of EUS-BD in achieving internal biliary drainage.
  • To discuss the role of EUS-BD in the multidisciplinary management of complex bilio-pancreatic diseases.

Main Methods:

  • Review of technical approaches for intra-hepatic and extra-hepatic EUS-BD, including hepatico-gastrostomy, choledocho-duodenostomy, and rendezvous techniques.
  • Synthesis of current clinical evidence comparing EUS-BD with PTBD and ERCP.
  • Discussion of EUS-BD's performance in challenging anatomies and during the same session as a failed ERCP.

Main Results:

  • EUS-BD demonstrates comparable or improved efficacy and enhanced safety profiles relative to PTBD for internal biliary drainage.
  • EUS-BD can be successfully performed immediately following a failed ERCP, offering a streamlined approach.
  • The technique is effective for both intra-hepatic and extra-hepatic biliary access, providing versatile therapeutic options.

Conclusions:

  • EUS-BD is a safe, effective, and feasible alternative to PTBD for patients with failed ERCP or complex biliary anatomy.
  • This endoscopic ultrasound-guided approach offers improved patient quality of life and reduces the need for re-interventions.
  • EUS-BD is increasingly recognized as a crucial component in the modern management of obstructive biliary diseases.