Sundaram S, Kale A. Endoscopic ultrasound guided biliary drainage in surgically altered anatomy: A comprehensive review of various approaches. World J Gastrointest Endosc 2023; 15(3): 122-132 [PMID: 37034975 DOI: 10.4253/wjge.v15.i3.122]
Corresponding Author of This Article
Sridhar Sundaram, MD, DM, FISG, Associate Professor, Department of Digestive Diseases and Clinical Nutrition, Tata Memorial Hospital, Homi Bhabha National Institute Mumbai, Dr. E Borges Road, Mumbai 400012, Maharashtra, India. drsridharsundaram@kem.edu
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Minireviews
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Endosc. Mar 16, 2023; 15(3): 122-132 Published online Mar 16, 2023. doi: 10.4253/wjge.v15.i3.122
Endoscopic ultrasound guided biliary drainage in surgically altered anatomy: A comprehensive review of various approaches
Sridhar Sundaram, Aditya Kale
Sridhar Sundaram, Department of Digestive Diseases and Clinical Nutrition, Tata Memorial Hospital, Homi Bhabha National Institute Mumbai, Mumbai 400012, Maharashtra, India
Aditya Kale, Department of Gastroenterology, Seth GS Medical College and King Edward Memorial Hospital, Mumbai 400012, India
Author contributions: Sundaram S contributed to conceptualization, data curation, formal analysis, project administration, resources, supervision, validation, writing-review and editing; Kale A contributed to data curation, formal analysis, investigation, visualization, writing-original draft.
Conflict-of-interest statement: Dr. Sridhar Sundaram and Dr. Aditya Kale have no conflicts of interest to declare.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Sridhar Sundaram, MD, DM, FISG, Associate Professor, Department of Digestive Diseases and Clinical Nutrition, Tata Memorial Hospital, Homi Bhabha National Institute Mumbai, Dr. E Borges Road, Mumbai 400012, Maharashtra, India. drsridharsundaram@kem.edu
Received: November 9, 2022 Peer-review started: November 9, 2022 First decision: November 30, 2022 Revised: December 20, 2022 Accepted: February 9, 2023 Article in press: February 9, 2023 Published online: March 16, 2023
Abstract
Endoscopic retrograde cholangiopancreatography (ERCP) is the preferred modality for drainage of the obstructed biliary tree. In patients with surgically altered anatomy, ERCP using standard techniques may not be feasible. Enteroscope assisted ERCP is usually employed with variable success rate. With advent of endoscopic ultrasound (EUS), biliary drainage procedures in patients with biliary obstruction and surgically altered anatomy is safe and effective. In this narrative review, we discuss role of EUS guided biliary drainage in patients with altered anatomy and the various approaches used in patients with benign and malignant biliary obstruction.
Core Tip: Endoscopic retrograde cholangiopancreatography is the mainstay for biliary drainage in benign and malignant biliary obstruction. Surgically altered anatomy poses a significant challenge to successful endoscopic retrograde cholangiopancreatography (ERCP). Enteroscopy assisted ERCP may need to be performed in this situation with variable rates of success. On the other hand, Endoscopic ultrasound guided biliary drainage represents a potential alternative to enteroscopy assisted ERCP. In patients with benign biliary obstruction, endoscopic ultrasound (EUS) guided rendezvous is the primary option for accessing the bile duct and ensuring clinical success of ERCP. In malignant obstruction, EUS guided antegrade intervention or transmural stent placement are options. EUS-BD ensures technical and clinical success is higher than 90% in expert hands.
