Endoscopic Ultrasound-Guided Biliary Drainage: A Systematic Review and Meta-Analysis

Efficacy and safety in case of technical success of endoscopic ultrasound-guided transhepatic antegrade biliary drainage: A report of a monocentric study

“…The clinical improvement was confirmed by the decrease of the total bilirubin level of more than one-third at 7 days and more than two-third at 1 month postoperatively. These results correlate with the actual published data about EUS-AD[211] and confirmed that the EUS-BD was a good alternative in case of failed retrograde biliary drainage. The main limitations of our study were the small number of patients and the retrospective feature.…”

“…Recent meta-analysis showed that EUS-guided biliary drainage (EUS-BD) is an emerging therapeutic modality with a pooled technical success rate between 90% and 95% with a cumulative adverse events rate between 14% and 17% for EUS-BD after failed ERCP. [23] These results are supported by a new prospective International Multicenter Study with technical and clinical success achieved in 95.7% and 95%, respectively, in intention-to-treat with an adverse events rate of 10.5% for patients with malignant distal biliary obstruction. [4] EUS-BD by rendezvous technique, choledochoduodenostomy (EUS-CDS), hepaticogastrostomy (EUS-HGS) and hepaticoduodenostomy, or antegrade (EUS-AD) stenting technique are the most common interventions encountered.…”

Updated guideline on the management of common bile duct stones (CBDS)

“…Once biliary access has been achieved, the endoscopist can then pass a wire to facilitate treatment, which can be performed in an antegrade fashion or combined with ERCP and retrograde therapy. A recent meta-analysis of (predominantly) retrospective cohort studies suggests this is a valid management option for biliary strictures 137. While appropriately trained clinicians may wish to consider EUS-guided access for selected cases of CBDS, it should be noted that there are limited data on its role in this setting and at present there are few centres that have the facilities and expertise to employ this approach routinely.…”

Clip and endoloop lifting technique to assist cannulation of a hardly reachable papilla because of anatomical changes due to surgery

“…With a correct cannulation technique, the complications associated with the procedure can be reduced (2). Different techniques have been used to improve the success rate of biliary cannulation: double guide wire technique, wire-guide cannulation over a pancreatic stent, transpancreatic sphinterotomy, needle-knife precut and endoscopic ultrasound-guided rendezvous (3,4). Recently, clip and snare lifting techniques have been described to assist cannulation of a papilla hidden behind a mucosal fold (5).…”