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World J Gastroenterol. Jan 21, 2016; 22(3): 1297-1303
Published online Jan 21, 2016. doi: 10.3748/wjg.v22.i3.1297
Endoscopic ultrasonography-guided biliary drainage: Who, when, which, and how?
Kazuo Hara, Kenji Yamao, Nobumasa Mizuno, Susumu Hijioka, Hiroshi Imaoka, Masahiro Tajika, Tutomu Tanaka, Makoto Ishihara, Nozomi Okuno, Nobuhiro Hieda, Tukasa Yoshida, Yasumasa Niwa
Kazuo Hara, Kenji Yamao, Nobumasa Mizuno, Susumu Hijioka, Hiroshi Imaoka, Nozomi Okuno, Nobuhiro Hieda, Tukasa Yoshida, Department of Gastroenterology, Aichi Cancer Center Hospital, Nagoya 464-8681, Japan
Masahiro Tajika, Tutomu Tanaka, Makoto Ishihara, Yasumasa Niwa, Department of Endoscopy, Aichi Cancer Center Hospital, Nagoya 464-8681, Japan
Author contributions: All authors equally contributed to this paper with literature review and analysis, drafting and critical revision and editing, and final approval of the final version.
Conflict-of-interest statement: No potential conflicts of interest. No financial support.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Kazuo Hara, MD, PhD, Department of Gastroenterology, Aichi Cancer Center Hospital, 1-1 Kanokoden, Tikusa-ku, Nagoya city 464-8681, Japan. khara@aichi-cc.jp
Telephone: +81-52-7626111
Received: August 8, 2015
Peer-review started: August 11, 2015
First decision: September 11, 2015
Revised: September 28, 2015
Accepted: November 13, 2015
Article in press: November 13, 2015
Published online: January 21, 2016
Processing time: 159 Days and 18.1 Hours
Abstract

Both endoscopic ultrasonography (EUS)-guided choledochoduodenostomy (EUS-CDS) and EUS-guided hepaticogastrostomy (EUS-HGS) are relatively well established as alternatives to percutaneous transhepatic biliary drainage (PTBD). Both EUS-CDS and EUS-HGS have high technical and clinical success rates (more than 90%) in high-volume centers. Complications for both procedures remain high at 10%-30%. Procedures performed by endoscopists who have done fewer than 20 cases sometimes result in severe or fatal complications. When learning EUS-guided biliary drainage (EUS-BD), we recommend a mentor’s supervision during at least the first 20 cases. For inoperable malignant lower biliary obstruction, a skillful endoscopist should perform EUS-BD before EUS-guided rendezvous technique (EUS-RV) and PTBD. We should be select EUS-BD for patients having altered anatomy from malignant tumors before balloon-enteroscope-assisted endoscopic retrograde cholangiopancreatography, EUS-RV, and PTBD. If both EUS-CDS and EUS-HGS are available, we should select EUS-CDS, according to published data. EUS-BD will potentially become a first-line biliary drainage procedure in the near future.

Keywords: Endoscopic ultrasonography; Endoscopic ultrasonography-guided biliary drainage; Interventional endoscopic ultrasonography; Endoscopic ultrasonography-guided choledochoduodenostomy; Endoscopic ultrasonography-guided rendezvous technique

Core tip: For inoperable malignant biliary obstruction, endoscopic ultrasonography (EUS)-guided biliary drainage (EUS-BD) should be selected before EUS-guided rendezvous technique or percutaneous transhepatic biliary drainage. EUS-BD is usually the first choice for patients having altered anatomy with malignant lower biliary obstruction. If both EUS-guided choledochoduodenostomy (EUS-CDS) and EUS-guided hepaticogastrostomy (EUS-HGS) are available, EUS-CDS should be selected. EUS-HGS has numerous potential complications compared to EUS-CDS. EUS-BD may well become a first-line biliary drainage procedure for malignant lower biliary obstruction in the near future.