Interventional EUS-guided cholangiography: evaluation of a technique in evolution

Fiberoptic Endoscopy: The Singular Transformative Event of Our Time

“…Comparable to endoscopy in general, EUS has evolved from a diagnostic to a therapeutic procedure, with the capability, for example, of draining pancreatic pseudocysts or transgastric bile duct puncture or stenting, supplanting surgical approaches [23,24]. The ability to directly visualize the entire small bowel promises to provide less morbid ways to diagnose and treat intestinal pathology [25,26].…”

One-step Placement of a Fully-covered Metal Stent in Endosonography-guided Biliary Drainage for Malignant Biliary Obstruction

“…Therefore, plastic stent placement via the puncture site to the target biliary duct is performed in the first session to prevent bile leakage in many reports (2)(3)(4)(5)(6)(7)(8)(9)(10)(11). Only a few case series undergoing ESBD with deployment of a covered self-expandable metal stent (SEMS) in a one-step fashion across the puncture site have been reported because there is a risk of migration of the deployed covered SEMS (5,7,8). Recently, a newly designed fully-covered SEMS with an anti-migration mechanism has become commercially available.…”

Decompression of Malignant Biliary Obstruction After Failed ERCP: To EUSBD and Not to PTBD?

“…Failure occurs due to operator inexperience, anatomic variation, tumor extension, prior surgery, and/or incomplete drainage [3,4]. Percutaneous transhepatic biliary drainage (PTBD) or surgical bypass is often employed after failed ERCP but is associated with a higher morbidity and mortality [3,5].…”

“…There is, however, a paucity of literature regarding comparison of EUSBD and PTBD. EUSBD may have advantages over PTBD including avoidance of vascular injury, lack of interference by ascites, and internal drainage within a single session [3,4,6,7]. Moreover, EUSBD can be successfully performed even in patients who have undergone total gastrectomy or partial gastrectomy with a Billroth II reconstruction.…”

“…EUS-RV can be divided into IHBD and EHBD approaches. Kahaleh et al [4] reported a lower risk of biliary leak with the IHBD approach, as compared to the EHBD approach. Theoretically, the IHBD approach may reduce the risk of bile leakage because the liver parenchyma around the bile duct can tamponade the fistula.…”