A multi-institution consensus on how to perform EUS-guided biliary drainage for malignant biliary obstruction

Jintao Guo¹, Marc Giovannini², Anand V Sahai³, Adrian Saftoiu⁴, Christoph F Dietrich⁵, Erwin Santo⁶, Pietro Fusaroli⁷, Ali A Siddiqui⁸, Manoop S Bhutani⁹, Anthony Yuen Bun Teoh¹⁰, Atsushi Irisawa¹¹, Brenda Lucia Arturo Arias¹², Chalapathi Rao Achanta¹³, Christian Jenssen¹⁴, Dong-Wan Seo¹⁵, Douglas G Adler¹⁶, Evangelos Kalaitzakis¹⁷, Everson Artifon¹⁸, Fumihide Itokawa¹⁹, Jan Werner Poley²⁰, Girish Mishra²¹, Khek Yu Ho²², Hsiu-Po Wang²³, Hussein Hassan Okasha²⁴, Jesse Lachter²⁵, Juan J Vila²⁶, Julio Iglesias-Garcia²⁷, Kenji Yamao²⁸, Kenjiro Yasuda²⁹, Kensuke Kubota³⁰, Laurent Palazzo³¹, Luis Carlos Sabbagh³², Malay Sharma³³, Mitsuhiro Kida³⁴, Mohamed El-Nady³⁵, Nam Q Nguyen³⁶, Peter Vilmann¹⁷, Pramod Kumar Garg³⁷, Praveer Rai³⁸, Shuntaro Mukai³⁹, Silvia Carrara⁴⁰, Sreeram Parupudi⁴¹, Subbaramiah Sridhar⁴², Sundeep Lakhtakia⁴³, Surinder S Rana⁴⁴, Takeshi Ogura⁴⁵, Todd H Baron⁴⁶, Vinay Dhir⁴⁷, Siyu Sun¹

Affiliations

¹ Endoscopy Center, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China.
² Pathology Unit (Flora Poizat), Institute Paoli-Calmettes, Marseille, France.
³ Center Hospitalier de l'Université de Montréal, Montreal, Canada.
⁴ Department of Endoscopy, University of Medicine and Pharmacy, Craiova, Romania.
⁵ Medical Department II, Caritas Hospital, Bad Mergentheim, Germany.
⁶ Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel.
⁷ Department of Medical and Surgical Sciences, Gastroenterology Unit, Hospital of Imola, University of Bologna, Bologna, Italy.
⁸ Division of Gastroenterology and Hepatology, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
⁹ Department of Gastroenterology, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
¹⁰ Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong.
¹¹ Department of Gastroenterology, Dokkyo Medical University, Mibu, Japan.
¹² Surgical Clinical Gastroenterolgy, Universidad de Caldas, Manizales, Colombia.
¹³ Gastroenterologist at Queen's NRI Hospital, Visakhapatnam, Andhra Pradesh, India.
¹⁴ Krankenhaus Märkisch Oderland Strausberg, Wriezen, Germany.
¹⁵ Department of Internal Medicine, Division of Gastroenterology, University of Ulsan College of Medicine, Seoul, South Korea.
¹⁶ Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA.
¹⁷ Division of Endoscopy, Gastro Unit, Copenhagen University Hospital Herlev, Copenhagen, Denmark.
¹⁸ Department of Surgery, University of Sao Paulo, Sao Paulo, Brazil.
¹⁹ Department of Gastroenterology and Hepatology, Tokyo Adventist Hospital, Tokyo, Japan.
²⁰ Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands.
²¹ Department of Gastroenterology, Wake Forest Baptist Health, Winston-Salem, North Carolina, USA.
²² Department of Medicine, National University of Singapore, Singapore, Singapore.
²³ Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan, China.
²⁴ Internal Medicine Department, Cairo University, Cairo, Egypt.
²⁵ Rambam Health Care Campus, Haifa, Israel.
²⁶ Endoscopy Unit, Complejo Hospitalario de Navarra, Pamplona, Spain.
²⁷ Department of Gastroenterology and Hepatology, University Hospital of Santiago de Compostela, Spain.
²⁸ Aichi Cancer Center Hospital, Nagoya, Japan.
²⁹ Department of Gastroenterology, Kyoto Second Red Cross Hospital, Kyoto, Japan.
³⁰ Department of Endoscopy, Yokohama City University School of Medicine, Yokohama, Japan.
³¹ Trocadero Clinic, Paris, France.
³² Clinica Reina Sofia, Bogota, Colombia.
³³ Department of Gastroenterology, Jaswant Rai Specialty Hospital, Meerut, Uttar Pradesh, India.
³⁴ Department of Gastroenterology, Kitasato University East Hospital, Sagamihara, Japan.
³⁵ Internal Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt.
³⁶ Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, North Terrace, Adelaide, Australia.
³⁷ Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India.
³⁸ Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.
³⁹ Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan.
⁴⁰ Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Research Hospital, Milan, Italy.
⁴¹ Texas Tech University Health Sciences Center, Lubbock, TX, USA.
⁴² Section of Gastroenterology/Hepatology, Augusta University, Augusta, GA, USA.
⁴³ Asian Institute of Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, Telangana, India.
⁴⁴ Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
⁴⁵ 2nd Department of Internal Medicine, Osaka Medical College, Osaka, Japan.
⁴⁶ Division of Gastroenterology, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
⁴⁷ Department of Gastroenterology, SL Raheja Hospital, Mumbai, Maharashtra, India.

PMID: 30531022
PMCID: PMC6289007
DOI: 10.4103/eus.eus_53_18

A multi-institution consensus on how to perform EUS-guided biliary drainage for malignant biliary obstruction

Jintao Guo et al. Endosc Ultrasound. 2018 Nov-Dec.

. 2018 Nov-Dec;7(6):356-365.

doi: 10.4103/eus.eus_53_18.

Authors

Affiliations

¹ Endoscopy Center, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China.
² Pathology Unit (Flora Poizat), Institute Paoli-Calmettes, Marseille, France.
³ Center Hospitalier de l'Université de Montréal, Montreal, Canada.
⁴ Department of Endoscopy, University of Medicine and Pharmacy, Craiova, Romania.
⁵ Medical Department II, Caritas Hospital, Bad Mergentheim, Germany.
⁶ Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel.
⁷ Department of Medical and Surgical Sciences, Gastroenterology Unit, Hospital of Imola, University of Bologna, Bologna, Italy.
⁸ Division of Gastroenterology and Hepatology, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
⁹ Department of Gastroenterology, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
¹⁰ Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong.
¹¹ Department of Gastroenterology, Dokkyo Medical University, Mibu, Japan.
¹² Surgical Clinical Gastroenterolgy, Universidad de Caldas, Manizales, Colombia.
¹³ Gastroenterologist at Queen's NRI Hospital, Visakhapatnam, Andhra Pradesh, India.
¹⁴ Krankenhaus Märkisch Oderland Strausberg, Wriezen, Germany.
¹⁵ Department of Internal Medicine, Division of Gastroenterology, University of Ulsan College of Medicine, Seoul, South Korea.
¹⁶ Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA.
¹⁷ Division of Endoscopy, Gastro Unit, Copenhagen University Hospital Herlev, Copenhagen, Denmark.
¹⁸ Department of Surgery, University of Sao Paulo, Sao Paulo, Brazil.
¹⁹ Department of Gastroenterology and Hepatology, Tokyo Adventist Hospital, Tokyo, Japan.
²⁰ Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands.
²¹ Department of Gastroenterology, Wake Forest Baptist Health, Winston-Salem, North Carolina, USA.
²² Department of Medicine, National University of Singapore, Singapore, Singapore.
²³ Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan, China.
²⁴ Internal Medicine Department, Cairo University, Cairo, Egypt.
²⁵ Rambam Health Care Campus, Haifa, Israel.
²⁶ Endoscopy Unit, Complejo Hospitalario de Navarra, Pamplona, Spain.
²⁷ Department of Gastroenterology and Hepatology, University Hospital of Santiago de Compostela, Spain.
²⁸ Aichi Cancer Center Hospital, Nagoya, Japan.
²⁹ Department of Gastroenterology, Kyoto Second Red Cross Hospital, Kyoto, Japan.
³⁰ Department of Endoscopy, Yokohama City University School of Medicine, Yokohama, Japan.
³¹ Trocadero Clinic, Paris, France.
³² Clinica Reina Sofia, Bogota, Colombia.
³³ Department of Gastroenterology, Jaswant Rai Specialty Hospital, Meerut, Uttar Pradesh, India.
³⁴ Department of Gastroenterology, Kitasato University East Hospital, Sagamihara, Japan.
³⁵ Internal Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt.
³⁶ Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, North Terrace, Adelaide, Australia.
³⁷ Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India.
³⁸ Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.
³⁹ Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan.
⁴⁰ Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Research Hospital, Milan, Italy.
⁴¹ Texas Tech University Health Sciences Center, Lubbock, TX, USA.
⁴² Section of Gastroenterology/Hepatology, Augusta University, Augusta, GA, USA.
⁴³ Asian Institute of Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, Telangana, India.
⁴⁴ Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
⁴⁵ 2nd Department of Internal Medicine, Osaka Medical College, Osaka, Japan.
⁴⁶ Division of Gastroenterology, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
⁴⁷ Department of Gastroenterology, SL Raheja Hospital, Mumbai, Maharashtra, India.

PMID: 30531022
PMCID: PMC6289007
DOI: 10.4103/eus.eus_53_18

Abstract

Background and objectives: EUS-guided biliary drainage (EUS-BD) was shown to be useful for malignant biliary obstruction (MBO). However, there is lack of consensus on how EUS-BD should be performed.

Methods: This was a worldwide multi-institutional survey among members of the International Society of EUS conducted in February 2018. The survey consisted of 10 questions related to the practice of EUS-BD.

Results: Forty-six endoscopists of them completed the survey. The majority of endoscopists felt that EUS-BD could replace percutaneous transhepatic biliary drainage after failure of ERCP. Among all EUS-BD methods, the rendezvous stenting technique should be the first choice. Self-expandable metal stents (SEMSs) were recommended by most endoscopists. For EUS-guided hepaticogastrostomy (HGS), superiority of partially-covered SEMS over fully-covered SEMS was not in agreement. 6-Fr cystotomes were recommended for fistula creation. During the HGS approach, longer SEMS (8 or 10 cm) was recommended. During the choledochoduodenostomy approach, 6-cm SEMS was recommended. During the intrahepatic (IH) approach, the IH segment 3 was recommended.

Conclusion: This is the first worldwide survey on the practice of EUS-BD for MBO. There were wide variations in practice, and randomized studies are urgently needed to establish the best approach for the management of this condition.

Keywords: Consensus; EUS-guided biliary drainage; questionnaire survey.

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Conflict of interest statement

There are no conflicts of interest

Figures

**Figure 1**
EUS-guided biliary drainage algorithm after failed ERCP for malignant obstruction

See this image and copyright information in PMC

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A multi-institution consensus on how to perform EUS-guided biliary drainage for malignant biliary obstruction

Affiliations

A multi-institution consensus on how to perform EUS-guided biliary drainage for malignant biliary obstruction

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

LinkOut - more resources

Full Text Sources