Endoscopic ultrasound-guided biliary drainage in benign biliary pathology with normal foregut anatomy: a multicenter study

Bill, Jason G.; Ryou, Marvin; Hathorn, Kelly; Cortés, Pedro; Maple, John T.; Al-Shahrani, Abdullah A.; Lang, Gabriel; Mullady, Daniel; Das, Koushik K.; Cosgrove, Natalie; Salameh, Habeeb; Kumta, Nikhil A.; DiMaio, Christopher J.; Zia, Hassaan; Orr, Jordan; Yachimski, Patrick; Kushnir, Vladimir

doi:10.1007/s00464-021-08418-w

Cited by 8 publications

(10 citation statements)

References 24 publications

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“…Both the indications for EUS-BD and the approach used vary widely among the published studies, making comparisons difficult to interpret. EUS-RV was the primary technique in three studies [57,60,63], while in the remaining studies transmural "tubular" self-expandable metal stent (SEMS) placement via various drainage pathways (i. e. HGS, CDS, or hepaticojejunostomy) was performed [58,59,61,62]. Technical success ranged between 77 % and 83 % in those studies involving EUS-RV [57,60,63].…”

Section: Do Different Eus-bd Approaches Have Different Success Rates In Benign Disease?mentioning

confidence: 99%

“…EUS-RV was the primary technique in three studies [57,60,63], while in the remaining studies transmural "tubular" self-expandable metal stent (SEMS) placement via various drainage pathways (i. e. HGS, CDS, or hepaticojejunostomy) was performed [58,59,61,62]. Technical success ranged between 77 % and 83 % in those studies involving EUS-RV [57,60,63]. When transmural drainage with a SEMS was used, technical and clinical success approached 100 % [24,58,59,61], with only one study reporting technical and clinical failures in 8 % of patients [62].…”

Section: Do Different Eus-bd Approaches Have Different Success Rates In Benign Disease?mentioning

confidence: 99%

“…In benign biliary disease, EUS-RV is the preferred technique, provided that the bile ducts are sufficiently dilated, as it does not permanently alter the bilioenteric anatomy. The technical success of the EUS-RV technique in benign disease (77 %) is lower than in malignant disease (90 %) and AEs are more likely to occur (27 %), owing to limited bile duct dilatation and technical difficulty in accessing small intrahepatic ducts 63 86 . Although no comparative studies are currently available, PTBD is also challenging in patients with benign disease, leading to a significant AE rate (21 %) and the frequent need for repeat procedures 71 .…”

Section: Biliary and Pancreatic Duct Drainagementioning

confidence: 99%

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Therapeutic endoscopic ultrasound: European Society of Gastrointestinal Endoscopy (ESGE) Guideline

et al. 2021

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Main Recommendations 1 ESGE recommends the use of endoscopic ultrasound-guided biliary drainage (EUS-BD) over percutaneous transhepatic biliary drainage (PTBD) after failed endoscopic retrograde cholangiopancreatography (ERCP) in malignant distal biliary obstruction when local expertise is available.Strong recommendation, moderate quality evidence. 2 ESGE suggests EUS-BD with hepaticogastrostomy only for malignant inoperable hilar biliary obstruction with a dilated left hepatic duct when inadequately drained by ERCP and/or PTBD in high volume expert centers.Weak recommendation, moderate quality evidence. 3 ESGE recommends that EUS-guided pancreatic duct (PD) drainage should only be considered in symptomatic patients with an obstructed PD when retrograde endoscopic intervention fails or is not possible.Strong recommendation, low quality evidence. 4 ESGE recommends rendezvous EUS techniques over transmural PD drainage in patients with favorable anatomy owing to its lower rate of adverse events.Strong recommendation, low quality evidence. 5 ESGE recommends that, in patients at high surgical risk, EUS-guided gallbladder drainage (GBD) should be favored over percutaneous gallbladder drainage where both techniques are available, owing to the lower rates of adverse events and need for re-interventions in EUS-GBD.Strong recommendation, high quality of evidence. 6 ESGE recommends EUS-guided gastroenterostomy (EUS-GE), in an expert setting, for malignant gastric outlet obstruction, as an alternative to enteral stenting or surgery.Strong recommendation, low quality evidence. 7 ESGE recommends that EUS-GE may be considered in the management of afferent loop syndrome, especially in the setting of malignancy or in poor surgical candidates. Strong recommendation, low quality evidence. 8 ESGE suggests that endoscopic ultrasound-directed transgastric ERCP (EDGE) can be offered, in expert centers, to patients with a Roux-en-Y gastric bypass following multidisciplinary decision-making, with the aim of overcoming the invasiveness of laparoscopy-assisted ERCP and the limitations of enteroscopy-assisted ERCP.Weak recommendation, low quality evidence.

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Section: Do Different Eus-bd Approaches Have Different Success Rates In Benign Disease?mentioning

confidence: 99%

Section: Do Different Eus-bd Approaches Have Different Success Rates In Benign Disease?mentioning

confidence: 99%

Section: Biliary and Pancreatic Duct Drainagementioning

confidence: 99%

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Therapeutic endoscopic ultrasound: European Society of Gastrointestinal Endoscopy (ESGE) Guideline

et al. 2021

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“…Endoscopic stenting for perihilar BBS is technically demanding due to stricture location at the biliary tree bifurcation, severe Role of EUS-BD in the treatment of benign biliary strictures EUS-BD can be a salvage technique in cases with BBS after failed ERCP [169]. EUS-RV is an effective option when papilla or hepaticojejunostomy anastomosis is accessible by a duodenoscope or enteroscope [170,171]. EUS-HGS facilitate rescue biliary drainage, especially in patients with surgically altered anatomy.…”

Section: Perihilar Benign Biliary Strictures (Figure 2)mentioning

confidence: 99%

Current endoscopic approaches to biliary strictures

Shimoda

Nakai

Fujishiro

2022

Current Opinion in Gastroenterology

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Purpose of reviewTo summarize the current status and future perspectives of the endoscopic management of biliary strictures.Recent findingsIn addition to conventional diagnostic modalities, such as cross-sectional imaging and endoscopic ultrasonography (EUS), per-oral cholangioscopy is helpful for indeterminate biliary strictures. It allows direct visualization of the biliary tract and targeted biopsy. For distal malignant biliary obstruction (MBO), a self-expandable metal stent (SEMS) via endoscopic retrograde cholangiopancreatography (ERCP) is a standard of care. EUS-guided biliary drainage (EUS-BD) is an emerging alternative to percutaneous transhepatic biliary drainage in cases with failed ERCP. EUS-BD is also an effective salvage option for perihilar MBO, which can not be managed via ERCP or percutaneous transhepatic biliary drainage. Preoperative drainage is necessary for most jaundiced patients as neoadjuvant chemotherapy is widely administered for resectable and borderline resectable pancreatic cancer, and a SEMS is preferred in this setting, too. For benign biliary strictures, a covered SEMS can improve stricture resolution and reduce the number of endoscopic sessions as compared to plastic stents.SummaryERCP and EUS play a central role in the diagnosis and drainage for both malignant and benign biliary strictures.

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“…4,5 Technical success, defined as successful guidewire passage into the small bowel to permit conventional ERCP, has been reported between 77 and 83%. [6][7][8] This has also been supported by a systematic review in which EUS-RV procedures were performed in both benign and malignant conditions with technical success rates approaching 90%. 2 AEs can exceed 13% in EUS-RV procedures, including post-procedure pain, bile leak, bleeding, and peritonitis.…”

Section: Direct Biliary Accessmentioning

confidence: 79%

Endoscopic Approaches to the Management of Biliary Tract Pathology: The Use of Therapeutic Endoscopic Ultrasound

Hosmer

2022

Digestive Disease Interventions

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Endoscopic ultrasound–guided biliary drainage (EUS-BD) procedures aid in the treatment of biliary diseases and can be considered in the setting of failed conventional endoscopic retrograde cholangiopancreatography, surgically altered gastrointestinal or biliary anatomy with an inaccessible major papilla, malignant obstruction precluding biliary access, or a contraindication to percutaneous biliary access. Although device innovations and technical improvements continue to advance the field of therapeutic EUS, further investigations are required. The purpose of this review is to highlight recent literature on the indications, techniques, capabilities, and outcomes of EUS-BD. Recent literature has demonstrated that EUS-BD is a safe and effective treatment option in the management of biliary diseases. Current studies have assessed the various EUS-BD techniques and have attempted to clarify the optimal treatment algorithm for those with complex biliary pathologies.

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Endoscopic ultrasound-guided biliary drainage in benign biliary pathology with normal foregut anatomy: a multicenter study

Cited by 8 publications

References 24 publications

Therapeutic endoscopic ultrasound: European Society of Gastrointestinal Endoscopy (ESGE) Guideline

Therapeutic endoscopic ultrasound: European Society of Gastrointestinal Endoscopy (ESGE) Guideline

Current endoscopic approaches to biliary strictures

Endoscopic Approaches to the Management of Biliary Tract Pathology: The Use of Therapeutic Endoscopic Ultrasound

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