Endoscopic Ultrasound-Guided Biliary Drainage (EUS-BD)

Area of Science:

• Gastroenterology
• Minimally Invasive Surgery

Background:

• Endoscopic retrograde cholangiopancreatography (ERCP) is the standard for biliary access.
• ERCP can be unsuccessful in certain cases, necessitating alternative approaches.
• Endoscopic ultrasound (EUS)-guided biliary drainage (BD) has emerged as a viable alternative.

Purpose of the Study:

• To review the techniques and outcomes of EUS-guided biliary drainage.
• To compare EUS-BD with conventional ERCP and percutaneous transhepatic biliary drainage (PTBD).

Main Methods:

• Review of different EUS-BD techniques based on access route (intrahepatic, extrahepatic) and stenting approach (rendezvous, antegrade, transluminal).
• Comparison of EUS-BD outcomes with ERCP and PTBD in terms of technical success, clinical success, and adverse events.

Main Results:

• EUS-BD can be performed via intrahepatic or extrahepatic routes, using various stenting methods.
• EUS-BD shows comparable or superior technical and clinical success rates compared to ERCP.
• EUS-BD is associated with lower adverse event rates than PTBD and does not require an external drain.

Conclusions:

• EUS-guided biliary drainage is an effective and safe minimally invasive procedure for achieving biliary access when ERCP fails.
• EUS-BD offers advantages over PTBD and comparable or better outcomes than ERCP.