Clinical practice guidelines for safe performance of endoscopic ultrasound/ultrasonography‐guided biliary drainage: 2018

Abstract

Endoscopic ultrasound/ultrasonography‐guided biliary drainage (EUS‐BD) is a relatively new modality for biliary drainage after failed or difficult transpapillary biliary cannulation. Despite its clinical utility, EUS‐BD can be complicated by severe adverse events such as bleeding, perforation, and peritonitis. The aim of this paper is to provide practice guidelines for safe performance of EUS‐BD as well as safe introduction of the procedure to non‐expert centers. The guidelines comprised patient–intervention–comparison–outcome‐formatted clinical questions (CQs) and questions (Qs), which are background statements to facilitate understanding of the CQs. A literature search was performed using the PubMed and Cochrane Library databases. Statement, evidence level, and strength of recommendation were created according to the GRADE system. Four committees were organized: guideline creation, expert panelist, evaluation, and external evaluation committees. We developed 13 CQs (methods, device selection, supportive treatment, management of adverse events, education and ethics) and six Qs (definition, indication, outcomes and adverse events) with statements, evidence levels, and strengths of recommendation. The guidelines explain the technical aspects, management of adverse events, and ethics of EUS‐BD and its introduction to non‐expert institutions.

Acute and subacute effects of irreversible electroporation on normal common bile ducts in a rabbit model

“…Moreover, endobiliary IRE ablation, with suitable catheter-based electrodes, can also be achieved via the drainage route of preoperative biliary drainage such as endoscopic ultrasonography-guided biliary drainage or percutaneous transhepatic biliary drainage. 28,29 In addition, for patients who can't tolerate curative surgery, IRE can serve as an alternative option for tumor reduction. This will allow opportunity for further curative surgery such as pancreaticoduodenectomy or bile duct resection.…”

A multicenter prospective randomized controlled trial for preoperative biliary drainage with uncovered metal versus plastic stents for resectable periampullary cancer

“…Although endoscopic ultrasound guided biliary drainage is suggested as a new salvage technique after failed F I G U R E 2 Regarding the rate of decrease of total bilirubin, there were no differences between the two groups in the following manner: regardless of bilirubin level (total patients); with respect to patients with total bilirubin level of more than 3 mg/dL; and with respect to patients with total bilirubin level of more than 10 mg/dL transpapillary biliary cannulation, it is not currently recommended for resectable biliary obstruction due to the limited evidence. 28 With respect to the types of SEMS, FCSEMS has usually been preferred for PBD because it provides the option of removal in the event of misdiagnosis. 7,9,29 In one study, nearly T A B L E 3 Outcomes after surgery F I G U R E 3 According to the stent indwelling period after insertion, there was no difference of any complication rates, including mortality, between the two groups 7% of patients with a suspected pancreatic malignancy were finally diagnosed with benign disease.…”

Technical feasibility and safety of transluminal antegrade dilation for hepaticojejunostomy stricture using a novel fine-gauge electrocautery dilator (with video)

“…Although enteroscopy is an established procedure for patients with surgically altered anatomy, rates of technical success are not very high [3]. Endoscopic ultrasound-guided biliary drainage (EUS-BD) [4][5][6][7] has been traditionally indicated for failed endoscopic retrograde cholangiopancreatography (ERCP) in patients with unresectable malignant biliary obstruction. Expanding indications for EUS-BD have recently been reported such as EUS-guided antegrade stone removal [8][9][10][11].…”