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Review
. 2019 May 16;11(5):354-364.
doi: 10.4253/wjge.v11.i5.354.

Comprehensive review on EUS-guided biliary drainage

Raffaele Salerno  1 , Sophia Elizabeth Campbell Davies  2 , Nicolò Mezzina  1 , Sandro Ardizzone  1
Affiliations
Review

Comprehensive review on EUS-guided biliary drainage

Raffaele Salerno et al. World J Gastrointest Endosc. .

Abstract

Feasibility of endoscopic retrograde cholangiopancreatography (ERCP) for biliary drainage is not always applicable due to anatomical alterations or to inability to access the papilla. Percutaneous transhepatic biliary drainage has always been considered the only alternative for this indication. However, endoscopic ultrasonography-guided biliary drainage represents a valid option to replace percutaneous transhepatic biliary drainage when ERCP fails. According to the access site to the biliary tree, two kinds of approaches may be described: the intrahepatic and the extrahepatic. Endoscopic ultrasonography-guided rendez-vous transpapillary drainage is performed where the second portion of the duodenum is easily reached but conventional ERCP fails. The recent introduction of self-expandable metal stents and lumen-apposing metal stents has improved this field. However, the role of the latter is still controversial. Echoendoscopic transmural biliary drainage can be challenging with potential severe adverse events. Therefore, trained endoscopists, in both ERCP and endoscopic ultrasonography are needed with surgical and radiological backup.

Keywords: EUS; Endoscopic ultrasonography-guided antegrade stent placement; Endoscopic ultrasonography-guided biliary drainage; Endoscopic ultrasonography-guided choledochoduodenostomy; Endoscopic ultrasonography-guided hepatogastric anastomosis; Endoscopic ultrasonography-guided rendezvous; Endoscopic ultrasonography-guided transgallbladder; Percutaneous transhepatic biliary drainage.

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Figures

Figure 1
Figure 1
The access points of different endoscopic ultrasonography-guided biliary drainage procedures. A: The intrahepatic approach; B: The extrahepatic approach.
Figure 2
Figure 2
Steps for endoscopic ultrasonography-guided biliary drainage: The crucial step for complication is enhanced in red. LHD: Left hepatic duct; CBD: Common bile duct; GB: Gallbladder; LAMS: Lumen apposing metal stent; EUS-BD: Endoscopic ultrasonography-guided biliary drainage; EUS-HGA: Endoscopic ultrasonography-guided hepatogastric anastomosis; EUS-CDS: Endoscopic ultrasonography-guided choledochoduodenostomy; EUS-RV: Endoscopic ultrasonography-guided rendez-vous.
See this image and copyright information in PMC

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