Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Feb 16, 2019; 11(2): 103-114
Published online Feb 16, 2019. doi: 10.4253/wjge.v11.i2.103
Endoscopic ultrasound-guided drainage of the biliary system: Techniques, indications and future perspectives
Pieter Hindryckx, Helena Degroote, David J Tate, Pierre H Deprez
Pieter Hindryckx, Helena Degroote, David J Tate, Department of Gastroenterology, University Hospital of Ghent, Ghent 9000, Belgium
Pierre H Deprez, Hepato-Gastroenterology Department, Cliniques universitaires Saint-Luc, Brussels 1200, Belgium
Author contributions: Hindryckx P and Degroote H drafted the manuscript, Tate DJ performed language editing, Deprez PH revised the manuscript for important intellectual content
Conflict-of-interest statement: None of the authors report conflicts of interest with regard to this manuscript.
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:
Corresponding author: Pieter Hindryckx, MD, PhD, Professor, Department of Gastroenterology, University Hospital of Ghent, Corneel Heymanslaan 10, Ghent 9000, Belgium.
Telephone: +32-9-3322371
Received: December 20, 2018
Peer-review started: December 21, 2019
First decision: January 6, 2019
Revised: January 23, 2019
Accepted: February 13, 2019
Article in press: February 13, 2019
Published online: February 16, 2019

Over the last decade, endoscopic ultrasound-guided biliary drainage (EUS-BD) has evolved into a widely accepted alternative to the percutaneous approach in cases of biliary obstruction with failed endoscopic retrograde cholangiopancreaticography (ERCP). The available evidence suggests that, in experienced hands, EUS-BD might even replace ERCP as the first-line procedure in specific situations such as malignant distal bile duct obstruction. The aim of this review is to summarize the available data on EUS-BD and propose an evidence-based algorithm clarifies the role of the different EUS-BD techniques in the management of benign and malignant biliary obstructive disease.

Keywords: Endoscopic ultrasound, Endoscopic retrograde cholangiopancreaticography, Biliary drainage, Rendez-vous, Hepaticogastrostomy, Choledochoduodenostomy

Core tip: Endoscopic ultrasound-guided biliary drainage (EUS-BD) has recently been introduced as a valuable approach case in patients with failed endoscopic retrograde cholangiopancreaticography (ERCP). Evidence suggests that EUS-BD is equally effective and safer than the percutaneous approach. EUS-BD has even been proposed as a first-line procedure (replacing ERCP) in selected indications. Various approaches for EUS-BD exist, depending on the type (malignant or benign) and location (distal or proximal) of the biliary obstruction, and the anatomy of the upper gastrointestinal tract (surgically altered or not). This review gives an overview of the technique and the available data of EUS-BD in several indications.