Endoscopic ultrasound guided biliary drainage: a comprehensive review

Abstract

Endoscopic ultrasound-guided biliary drainage (EUS-BD) has become widely accepted over the past several years for complicated biliary drainage. When conventional endoscopic retrograde cholangiopancreatography (ERCP) is not successful or feasible due to a variety of constraints, an ultrasoundguided technique through intrahepatic and extrahepatic approaches allows adequate management of hepatobiliary obstruction. Other management alternatives include percutaneous transhepatic biliary drainages (PTBD) and complicated surgical approaches, both of which can be associated with increased morbidity and mortality. There are various technical approaches to allow successful biliary drainage which will be reviewed in this article.

GRUPUGE PERSPECTIVE: Endoscopic Ultrasound-Guided Biliary Drainage

“…The same plane should be maintained in order to assure axial force transmission, confirmed by guidewire monitorization on the ultrasound image or fluoroscopic control [26].…”

“…HGS is performed in cases of proximal bile duct obstruction with inaccessible papilla or failed cannulation, when the left lobe cannot be drained by ERCP, in cases of surgically altered anatomy or gastric outlet obstruction. Some experts prefer HGS in cases of distal malignant obstruction [24, 26]. HGS should only be performed in cases with significant dilation of the left intrahepatic ducts.…”

“…HGS should only be performed in cases with significant dilation of the left intrahepatic ducts. Segment III is the preferred puncture site [25, 26]. Contraindications to HGS include tumor infiltration of the stomach wall (absolute) and massive ascites, coagulopathy or lack of bile ducts dilation (relative) [25].…”

Multidisciplinary Approach to Malignant Biliary Obstruction

“…6), respectively; (3) accessing the biliary system as described and then dilating a tract, advancing a guidewire antegrade across the obstruction allowing for antegrade stenting of the obstruction through the dilated tract; and (4) accessing the dilated biliary system and advancing a guidewire antegrade through the obstruction into the duodenum then grasping it with forceps to assist with a retrograde ERCP (rendezvous technique). 26 Plastic stents were initially used for this technique; however, lumen-apposing metal stent (LAMS) such as the AXIOS stent (Boston Scientific, Marlborough, MA) have become the device of choice given lower incidence of complications with their use. Potential complications of EUS-BD include bleeding (4.03%), bile leakage (4.03%), pneumoperitoneum (3.02%), stent migration (2.68%), cholangitis (2.43%), abdominal pain (1.51%), and peritonitis (1.26%; ►Fig.…”

Endovascular hemostasis for endoscopic procedure-related gastrointestinal bleeding

“…The choice of EUS-guided biliary drainage depends on the inherent reason for failed conventional ERCP, patient anatomy, indication for biliary drainage, and operator preference. 43 In a recent meta-analysis, the bleeding risk associated with EUS-guided biliary drainage is 4.03%. 44 Most bleeding complications can initially be treated conservatively, however, additional procedures such as embolization can be necessary for hemostasis (Fig.…”