Endoscopic ultrasonography guided biliary drainage: summary of consortium meeting, May 7th, 2011, Chicago

Abstract

Endoscopic retrograde cholangiopancreatography (ERCP) has become the preferred procedure for biliary or pancreatic drainage in various pancreatico-biliary disorders. With a success rate of more than 90%, ERCP may not achieve biliary or pancreatic drainage in cases with altered anatomy or with tumors obstructing access to the duodenum. In the past those failures were typically managed exclusively by percutaneous approaches by interventional radiologists or surgical intervention. The morbidity associated was significant especially in those patients with advanced malignancy, seeking minimally invasive interventions and improved quality of life. With the advent of biliary drainage via endoscopic ultrasound (EUS) guidance, EUS guided biliary drainage has been used more frequently within the last decade in different countries. As with any novel advanced endoscopic procedure that encompasses various approaches, advanced endoscopists all over the world have innovated and adopted diverse EUS guided biliary and pancreatic drainage techniques. This diversity has resulted in variations and improvements in EUS Guided biliary and pancreatic drainage; and over the years has led to an extensive nomenclature. The diversity of techniques, nomenclature and recent progress in our intrumentation has led to a dedicated meeting on May 7(th), 2011 during Digestive Disease Week 2011. More than 40 advanced endoscopists from United States, Brazil, Mexico, Venezuela, Colombia, Italy, France, Austria, Germany, Spain, Japan, China, South Korea and India attended this pivotal meeting. The meeting covered improved EUS guided biliary access and drainage procedures, terminology, nomenclature, training and credentialing; as well as emerging devices for EUS guided biliary drainage. This paper summarizes the meeting's agenda and the conclusions generated by the creation of this consortium group.

Keywords: Biliary drainage; Endoscopic retrograde cholangiopancreatography; Endoscopic ultrasound; Endoscopic ultrasound guided; Endosonography-guided cholangiopancreatography; Pancreatic drainage.

Figure 1

Therapeutic endosonographic cholangiopancreatography: Variant approaches. 1: Transmural drainage, intrahepatic access (hepaticogastrostomy); 2: Transmural drainage, extrahepatic access (choledochoduodenostomy); 3: Transpapillary drainage, intrahepatic access; 4: Transpapillary drainage, extrahepatic access; 5: Transmural drainage, pancreatic access (pancreaticogastrostomy); 6: Transpapillary drainage, pancreatic access. (Reprinted from Perez-Miranda et al[41] with permission).

Figure 2

Pancreaticobiliary phantom model (Olympus Medical Systems).