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Endoscopic Procedures V: ERCP

Endoscopic Procedures V: ERCP

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.
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Updated: Aug 15, 2025

Endoscopic Ultrasound-Guided Biliary Drainage: Endoscopic Ultrasound-Guided Hepaticogastrostomy in Malignant Biliary Obstruction

Endoscopic Ultrasound-Guided Biliary Drainage: Endoscopic Ultrasound-Guided Hepaticogastrostomy in Malignant Biliary Obstruction

Published on: March 25, 2022

EUS-guided transenteric pancreatic duct drainage.

¹Head of Gastroenterology and Endoscopy Department, Paoli-Calmettes Institute, Marseille, France.

Best Practice & Research. Clinical Gastroenterology

|December 28, 2022

Summary

Endoscopic retrograde cholangiopancreatography (ERCP) drainage can be challenging. Endoscopic ultrasound (EUS)-guided pancreatic duct drainage offers an alternative when ERCP fails, but it is technically demanding.

Keywords:

EUS guided Pancreatic duct drainage Failed ERCP Rendez-vous technique

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Area of Science:

Gastroenterology
Interventional Endoscopy
Medical Imaging

Background:

Transpapillary access to the pancreatic duct is standard for endoscopic retrograde cholangiopancreatography (ERCP) drainage.
ERCP failure necessitates alternative approaches for pancreatic duct (PD) drainage.
Endoscopic ultrasound (EUS)-guided interventions are emerging as viable alternatives to surgery.

Purpose of the Study:

To evaluate EUS-guided pancreatico-gastro or bulbostomy and/or rendez-vous techniques as alternatives to surgery for PD drainage.
To highlight the technical challenges and considerations in EUS-guided PD drainage.
To assess the safety and efficacy of EUS-guided PD drainage.

Main Methods:

Review of EUS-guided pancreatico-gastro or bulbostomy and/or rendez-vous techniques.
Analysis of device selection considerations for EUS-guided PD drainage.
Evaluation of complication risks associated with EUS-guided PD drainage.

Main Results:

EUS-guided pancreatico-gastro or bulbostomy and/or rendez-vous techniques provide an alternative when ERCP fails.
The procedure has demonstrated safety and effectiveness.
EUS-guided PD drainage is technically challenging, requiring careful device selection.

Conclusions:

EUS-guided pancreatic duct drainage is a feasible alternative to surgery for complex cases.
Technical expertise and careful planning are crucial for successful EUS-guided PD drainage.
Minimizing severe complications is a key consideration in this challenging interventional EUS procedure.