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Year : 2022  |  Volume : 11  |  Issue : 5  |  Page : 342-354

How to perform EUS-guided biliary drainage

1 Department of Ultrasound, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China; Department of Allgemeine Innere Medizin der Kliniken (DAIM) Hirslanden Beau Site, Salem und Permanence, Bern, Switzerland
2 Translational Gastroenterology Unit, Oxford University Hospitals, Oxford, UK
3 Hepato-Pancreatico-Biliary Unit, Groote Schuur Hospital, Cape Town, South Africa
4 Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
5 Division of Pancreatobiliary Endoscopy and Endosonography, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
6 Department of Gastroenterology Hepatology and Nutrition, UTMD Anderson Cancer Center, Houston, Texas, USA
7 Department of Gastroenterology and Hepatology, München Klinik Neuperlach und Harlaching, Munich, Germany
8 Royal Infirmary of Edinburgh, Edinburgh, UK
9 Medical Department II, Helios Klinikum Meiningen, Meiningen, Germany
10 Department of Gastroenterology, Allgemeines Krankenhaus Celle, Celle, Germany
11 Caritas-Krankenhaus, Bad Mergentheim, Germany
12 Medical Department, Krankenhaus Maerkisch-Oderland, Strausberg and Brandenburg Institute of Clinical Ultrasound at Medical University Brandenburg, Neuruppin, Germany
13 Department of Gastroenterology, Charite, Berlin, Germany
14 Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
15 Department of Medical I/Gastroenterology, SANA Hospital Lichtenberg, Berlin, Germany
16 Hopital Privé J Mermoz Ramsay Générale de Santé, Lyon, France
17 Department of Gastroenterology, Clinic of Internal Medicine, Colentina Clinical Hospital, Carol Davila University of Medicine, Bucharest, Romania
18 Department of Gastroenterology, Research Center of Gastroenterology and Hepatology, University of Medicine and Pharmacy Craiova, Craiova, Romania
19 Department of Endoscopy Center, Shengjing Hospital of China Medical University, Liaoning Province, China
20 Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
21 Department of Medical and Surgical Sciences, Gastrointestinal Unit, University of Bologna/Hospital of Imola, Imola, Italy
22 Division of Gastroenterology, Humanitas Clinical and Research Center, Digestive Endoscopy Unit, Milan, Italy
23 Department of Gastroenterology, SRH Klinikum Gera, Gera, Germany
24 Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
25 Medizinische Klinik I, Sana Kliniken Luebeck, Luebeck, Germany

Correspondence Address:
Christoph F Dietrich
Department Allgemeine Innere Medizin, Kliniken Hirslanden Beau Site, Salem und Permancence, Bern

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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/EUS-D-21-00188

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EUS-guided biliary drainage (EUS-BD) has recently gained widespread acceptance as a minimally invasive alternative method for biliary drainage. Even in experienced endoscopy centers, ERCP may fail due to inaccessibility of the papillary region, altered anatomy (particularly postsurgical alterations), papillary obstruction, or neoplastic gastric outlet obstruction. Biliary cannulation fails at first attempt in 5%–10% of cases even in the absence of these factors. In such cases, alternative options for biliary drainage must be provided since biliary obstruction is responsible for poor quality of life and even reduced survival, particularly due to septic cholangitis. The standard of care in many centers remains percutaneous transhepatic biliary drainage (PTBD). However, despite the high technical success rate with experienced operators, the percutaneous approach is more invasive and associated with poor quality of life. PTBD may result in long-term external catheters for biliary drainage and carry the risk of serious adverse events (SAEs) in up to 10% of patients, including bile leaks, hemorrhage, and sepsis. PTBD following a failed ERCP also requires scheduling a second procedure, resulting in prolonged hospital stay and additional costs. EUS-BD may overcome many of these limitations and offer some distinct advantages in accessing the biliary tree. Current data suggest that EUS-BD is safe and effective when performed by experts, although SAEs have been also reported. Despite the high number of clinical reports and case series, high-quality comparative studies are still lacking. The purpose of this article is to report on the current status of this procedure and to discuss the tools and techniques for EUS-BD in different clinical scenarios.

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