Endoscopic Ultrasound-Guided Biliary Drainage for Benign Biliary Diseases

Abstract

Although endoscopic retrograde cholangiopancreatography (ERCP) is the first-line treatment for benign biliary diseases, this procedure is technically difficult in some conditions such as a surgically altered anatomy and gastric outlet obstruction. After a failed ERCP, a surgical or a percutaneous approach is selected as a rescue procedure; however, various endoscopic ultrasound (EUS)-guided interventions are increasingly utilized in pancreatobiliary diseases, including EUS-guided rendezvous for failed biliary cannulation, EUS-guided antegrade treatment for stone management, and EUS-guided hepaticogastrostomy for anastomotic strictures in patients with a surgically altered anatomy. There are some technical hurdles in EUS-guided interventions for benign biliary diseases owing to the difficulty in puncturing a relatively small bile duct and in subsequent guidewire manipulation, as well as the lack of dedicated devices. A recent major advancement in this field is the introduction of a 2-step approach, in which EUS-guided drainage is placed in the first session and antegrade treatment is performed in subsequent sessions. This approach allows the use of various techniques such as mechanical lithotripsy and cholangioscopy without a risk of bile leak. In summary, EUS-guided interventions are among the treatment options for benign biliary diseases; however, standardization of the procedure and development of a treatment algorithm are needed.

Relief of biliary obstruction: choosing between endoscopic ultrasound and endoscopic retrograde cholangiopancreatography

“…Though standardisation of the procedure with dedicated devices are still needed. 97 Additionally, a few contraindications to EUS-BD include severe coagulopathy, inability to visualise the biliary tract, and presence of intervening vessels or large volume ascites. 23 97 …”

Management of Difficult Bile Duct Stones by Large Balloon, Cholangioscopy, Enteroscopy and Endosonography

“…When the right intrahepatic bile duct approach is necessary, percutaneous transhepatic biliary drainage should be selected. We previously proposed this algorithm in our review 52 and clinical outcomes of this algorithm should be confirmed in prospective studies. Finally, both enteroscopy-assisted ERCP and EUS-AG stone treatment need expertise as well as dedicated devices, and we recommend those procedures should be performed by experts in high volume centers.…”

Piercing technique via cholangioscopy for the reconstruction of complete anastomotic obstruction after choledochojejunostomy

“…2c,d) (Video S1). Although most CJs are treatable by BE‐ERCP or EUS‐guided procedure, 2–5 some cases require other approaches. To avoid invasive surgery, the piercing technique for cases of complete obstruction of CJs and the percutaneous route for taking the correct direction are useful.…”