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World J Gastrointest Endosc. Aug 16, 2021; 13(8): 302-318
Published online Aug 16, 2021. doi: 10.4253/wjge.v13.i8.302
Endoscopic ultrasound-guided biliary drainage: Are we there yet?
Rishi Pawa, Troy Pleasant, Chloe Tom, Swati Pawa
Rishi Pawa, Troy Pleasant, Swati Pawa, Department of Internal Medicine, Section of Gastroenterology and Hepatology, Wake Forest Baptist Medical Center, Winston-Salem, NC 27157, United States
Chloe Tom, Department of Medicine, Wake Forest School of Medicine, Winston-Salem, NC 27101, United States
Author contributions: Pawa R provided topic outlining, literature review, expertise, graphics, original draft preparation and manuscript editing; Pleasant T and Tom C performed original draft preparation; Pawa S performed the expertise and manuscript editing; Pleasant T, Tom C, and Pawa S performed topic outlining, literature review.
Conflict-of-interest statement: None of the authors have any conflict of interests.
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: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Rishi Pawa, MBBS, Doctor, Department of Internal Medicine, Section of Gastroenterology and Hepatology, Wake Forest Baptist Medical Center, Medical Center Blvd, Winston-Salem, NC 27157, United States. rpawa@wakehealth.edu
Received: March 17, 2021
Peer-review started: March 17, 2021
First decision: May 4, 2021
Revised: May 14, 2021
Accepted: July 14, 2021
Article in press: July 14, 2021
Published online: August 16, 2021
Abstract

Endoscopic retrograde cholangiopancreatography (ERCP) is the mainstay procedure of choice for management of obstructive biliary disease. While ERCP is widely performed with high success rates, the procedure is not feasible in every patient such as cases of non-accessible papilla. In the setting of unsuccessful ERCP, endoscopic ultrasound-guided biliary drainage (EUS-BD) has become a promising alternative to surgical bypass and percutaneous biliary drainage (PTBD). A variety of different forms of EUS-BD have been described, allowing for both intrahepatic and extrahepatic approaches. Recent studies have reported high success rates utilizing EUS-BD for both transpapillary and transluminal drainage, with fewer adverse events when compared to PTBD. Advancements in novel technologies designed specifically for EUS-BD have led to increased success rates as well as improved safety profile for the procedure. The techniques of EUS-BD are yet to be fully standardized and are currently performed by highly trained advanced endoscopists. The aim of our review is to highlight the different EUS-guided interventions for achieving biliary drainage and to both assess the progress that has been made in the field as well as consider what the future may hold.

Keywords: Endoscopic ultrasound-guided biliary drainage, Endoscopic ultrasound-guided rendezvous, Endoscopic ultrasound-guided choledochoduodenostomy, Endoscopic ultrasound-guided hepaticogastrostomy, Endoscopic ultrasound-guided gallbladder drainage, Endoscopic ultrasound-directed transgastric endoscopic retrograde cholangiopancreatography

Core Tip: Endoscopic ultrasound-guided biliary drainage (EUS-BD) has emerged as a promising procedure for the management of obstructive biliary disease following failed endoscopic retrograde cholangiography. A number of different techniques have been described, with both intrahepatic and extrahepatic approaches. Using EUS-BD, either transpapillary or transluminal biliary decompression can be attained. Increased experience in these techniques along with introduction of novel devices and stents has led to improved outcomes when performing EUS-BD.