Endoscopic ultrasound-guided biliary drainage as an alternative to percutaneous drainage and surgical bypass

Abstract

Endoscopic retrograde cholangiopancreatography had been a treatment modality of choice for both benign and malignant biliary tract obstruction for more than half century, with a very high clinical success rate and low complications. But in certain circumstances, such as advanced and locally advanced pancreatobiliary malignancies (pancreatic cancer, cholangiocarcinoma, ampullary tumor) and tight benign strictures, endoscopic retrograde cholangiopancreatography (ERCP) fails. Up to this point, the only alternative interventions for these conditions were percutaneous transhepatic biliary drainage or surgery. Endoscopic ultrasound guided interventions was introduced for a couple decades with the better visualization and achievement of the pancreatobiliary tract. And it’s still in the process of ongoing development. The inventions of new techniques and accessories lead to more feasibility of high-ended procedures. Endoscopic ultrasound guided biliary drainage was a novel treatment modality for the patient who failed ERCP with the less invasive technique comparing to surgical bypass. The technical and clinical success was high with acceptable complications. Regarded the ability to drain the biliary tract internally without an exploratory laparotomy, this treatment modality became a very interesting procedures for many endosonographers, worldwide, in a short period. We have reviewed the literature and suggest that endoscopic ultrasound-guided biliary drainage is also an option, and one with a high probability of success, for biliary drainage in the patients who failed conventional endoscopic drainage.

Keywords: Endoscopic ultrasound, Endoscopic ultrasound, Biliary drainage, Choledochoduodenostomy, Hepaticogastrostomy, Technique

Core tip: Failure of endoscopic retrograde cholangiopancreatography occurs in 5%-10% of the cases from many etiologies. However, there are few alternative options for biliary drainage up to the present time. Percutaneous biliary drainage and surgical bypass have their own drawbacks. Endoscopic ultrasound guided biliary drainage (EUS-BD) is a new platform with a very high technical and clinical success rate with an acceptable complications. This review focused on the techniques, instruments including tips and tricks of this treatment modality. EUS-BD would become another alternative options for biliary drainage for both benign and malignant conditions in the future.