Prospective Study
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. May 16, 2018; 10(5): 99-108
Published online May 16, 2018. doi: 10.4253/wjge.v10.i5.99
Different options of endosonography-guided biliary drainage after endoscopic retrograde cholangio-pancreatography failure
José Celso Ardengh, César Vivian Lopes, Rafael Kemp, José Sebastião dos Santos
José Celso Ardengh, Rafael Kemp, José Sebastião dos Santos, Division of Surgery and Anatomy, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo 14049-900, Brazil
César Vivian Lopes, Department of Gastroenterology and Digestive Endoscopy, Santa Casa Hospital, Porto Alegre 91410-000, Brazil
Author contributions: Ardengh JC performed the procedures; Lopes CV designed the study and wrote the manuscript; Kemp R and dos Santos JS provided the collection of all human material.
Institutional review board statement: The institutional review board statement was approved by protocol No. 2.191.319.
Informed consent statement: All study participants, or their legal guardians, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: No potential conflicts of interest relevant to this article were reported.
Data sharing statement: No additional data are available.
Open-Access: 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:
Correspondence to: César Vivian Lopes, MD, PhD, Doctor, Department of Gastroenterology and Digestive Endoscopy, Santa Casa Hospital, Rua Prof. Cristiano Fischer 668/1001, Porto Alegre 91410-000, Brazil.
Telephone: +55-51-33388054
Received: January 9, 2018
Peer-review started: January 10, 2018
First decision: January 23, 2018
Revised: February 10, 2018
Accepted: March 14, 2018
Article in press: March 15, 2018
Published online: May 16, 2018

To investigate the success rates of endosonography (EUS)-guided biliary drainage (EUS-BD) techniques after endoscopic retrograde cholangiopancreatography (ERCP) failure for management of biliary obstruction.


From Feb/2010 to Dec/2016, ERCP was performed in 3538 patients, 24 of whom (0.68%) suffered failure to cannulate the biliary tree. All of these patients were initially submitted to EUS-guided rendez-vous (EUS-RV) by means of a transhepatic approach. In case of failure, the next approach was an EUS-guided anterograde stent insertion (EUS-ASI) or an EUS-guided hepaticogastrostomy (EUS-HG). If a transhepatic approach was not possible or a guidewire could not be passed through the papilla, EUS-guided choledochoduodenostomy (EUS-CD) was performed.


Patients were submitted to EUS-RV (7), EUS-ASI (5), EUS-HG (6), and EUS-CD (6). Success rates did not differ among the various EUS-BD techniques. Overall, technical and clinical success rates were 83.3% and 75%, respectively. Technical success for each technique was, 71.4%, 100%, 83.3%, and 83.3%, respectively (P = 0.81). Complications occurred in 3 (12.5%) patients. All of these cases were managed conservatively, but one patient died after rescue percutaneous transhepatic biliary drainage (PTBD).


The choice of a particular EUS-BD technique should be based on patient’s anatomy and on whether the guidewire could be passed through the duodenal papilla.

Keywords: Cholestasis, Drainage, Endosonography, Interventional procedures, Jaundice, Neoplasms

Core tip: Endosonography-guided biliary drainage is an effective alternative in the failure of endoscopic retrograde cholangiopancreatography, with the potential to provide the least invasive and the lowest risk therapeutic modality for biliary drainage when compared to percutaneous transhepatic biliary drainage or surgery. For this procedure, access to the biliary tree can be obtained by transhepatic or transduodenal approaches. However, the transhepatic approach offers a good acoustic window for puncture of the biliary tree, a straight and easier to work with position of the echoendoscope, a better positioning of the guidewire, and a lower chance of bleeding or choleperitoneum.