Controversies in Endoscopic Ultrasound-Guided Biliary Drainage

Area of Science:

• Gastroenterology
• Interventional Endoscopy

Background:

• Endoscopic retrograde cholangiography (ERC) remains the standard for therapeutic biliary access.
• EUS-guided biliary drainage has emerged as a safe and effective alternative.
• Technical challenges and limited training models exist for EUS-guided procedures.

Purpose of the Study:

• To compare various EUS-guided biliary drainage techniques.
• To discuss debated aspects of EUS-guided biliary drainage in current literature and practice.
• To analyze alternative biliary drainage options, including percutaneous transhepatic cholangiodrainage.

Main Methods:

• Review and comparison of existing literature on EUS-guided biliary drainage.
• Discussion of different access routes and technical modifications for EUS procedures.
• Comparative analysis of EUS-guided drainage versus ERC and percutaneous transhepatic cholangiodrainage.

Main Results:

• EUS-guided biliary drainage is a viable alternative to ERC, particularly in complex cases.
• Technical modifications and specific instruments are crucial for different EUS access routes.
• Percutaneous transhepatic cholangiodrainage is a strong alternative in experienced hands.

Conclusions:

• EUS-guided biliary drainage techniques are evolving and offer significant benefits.
• Addressing technical demands and improving training are essential for wider adoption.
• A comparative approach aids in selecting the optimal biliary drainage strategy.