Published online Mar 7, 2020. doi: 10.3748/wjg.v26.i9.947
Peer-review started: December 6, 2019
First decision: January 12, 2020
Revised: February 13, 2020
Accepted: February 21, 2020
Article in press: February 21, 2020
Published online: March 7, 2020
Since it was initially described in 2001, endoscopic ultrasound-guided biliary drainage (EUS-BD) has been developed as an alternative therapeutic technique for biliary obstruction. Although many EUS-BD techniques are available, the optimal algorithm of EUS-BD techniques has not yet been well established.
To date, limited data are available on troubleshooting when the initial EUS-BD plan is challenging. When it was difficult to accomplish the initial EUS-BD procedure, we attempted to convert the puncture target or drainage method in the same endoscopic session.
This study aimed to evaluate the usefulness of converting the treatment methods during a single endoscopic session for difficult cases in initially planned EUS-BD.
Patients with biliary obstruction undergoing EUS-BD between May 2008 and April 2016 in a single tertiary-care center were retrospectively reviewed based on our prospectively accumulated database.
During the study period, 208 patients underwent EUS-BD. In 18.8% of the patients, the treatment methods were converted from the initial plan. The technical and clinical success rates of the conversion cases were 97.4% and 89.5%, respectively. The rate of AEs was 10.3% and all were graded as mild. Puncture target and drainage technique were altered in 25 and 14 cases, respectively. The final technical success rate of all the 208 cases was 97.1%, and that of the initially planned EUS-BD was 78.8%.
When initially planned EUS-BD is technically challenging, alteration of treatment methods during the single endoscopic session contributed to improvements in the technical success of EUS-BD, without incurring serious AEs.
Future, multicenter, and prospective studies with larger cohorts are necessary to confirm the suitability and utility of converting the treatment methods in the same endoscopic session from the initially planned EUS-BD technique.