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World J Gastrointest Endosc. Dec 16, 2021; 13(12): 607-618
Published online Dec 16, 2021. doi: 10.4253/wjge.v13.i12.607
Endoscopic ultrasound-guided biliary drainage-current status and future perspectives
Petko Ivanov Karagyozov, Ivan Tishkov, Irina Boeva, Kiril Draganov
Petko Ivanov Karagyozov, Ivan Tishkov, Irina Boeva, Department of Interventional Gastroenterology, Clinic of Gastroenterology, Acibadem City Clinic Tokuda Hopsital, Sofia 1407, Bulgaria
Kiril Draganov, Clinic of Liver, Biliary, Pancreatic and General Surgery, Acibadem City Clinic Tokuda Hospital, Sofia 1407, Bulgaria
Author contributions: Karagyozov PI, and Boeva I, wrote the manuscript; Tishkov I prepared all the figures and the table; Draganov K revised, corrected and approved the manuscript.
Conflict-of-interest statement: Petko Karagyozov has received fees for proctoring SpyGlass DS procedures from Boston Scientific Corp.
Open-Access: This article is an open-access article that 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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Petko Ivanov Karagyozov, MD, PhD, FASGE, Chief Doctor, Department of Interventional Gastroenterology, Clinic of Gastroenterology, Acibadem City Clinic Tokuda University Hospital, 51B N. Vaptzarov Blvd., Sofia 1407, Bulgaria. petko.karagyozov@gmail.com
Received: March 19, 2021
Peer-review started: March 19, 2021
First decision: May 4, 2021
Revised: May 17, 2021
Accepted: November 24, 2021
Article in press: November 24, 2021
Published online: December 16, 2021
Processing time: 269 Days and 17.2 Hours
Abstract

Endoscopic retrograde cholangiopancreatography (ERCP) with stenting is the treatment modality of choice for patients with benign and malignant bile duct obstruction. ERCP could fail in cases of duodenal obstruction, duodenal diverticulum, ampullary neoplastic infiltration or surgically altered anatomy. In these cases percutaneous biliary drainage (PTBD) is traditionally used as a rescue procedure but is related to high morbidity and mortality and lower quality of life. Endoscopic ultrasound-guided biliary drainage (EUS-BD) is a relatively new interventional procedure that arose due to the development of curvilinear echoendoscope and the various endoscopic devices. A large amount of data is already collected that proves its efficacy, safety and ability to replace PTBD in cases of ERCP failure. It is also possible that EUS-BD could be chosen as a first-line treatment option in some clinical scenarios in the near future. Several EUS-BD techniques are developed EUS-guided transmural stenting, antegrade stenting and rendezvous technique and can be personalized depending on the individual anatomy. EUS-BD is normally performed in the same session from the same endoscopist in case of ERCP failure. The lack of training, absence of enough dedicated devices and lack of standardization still makes EUS-BD a difficult and not very popular procedure, which is related to life-threatening adverse events. Developing training models, dedicated devices and guidelines hopefully will make EUS-BD easier, safer and well accepted in the future. This paper focuses on the technical aspects of the different EUS-BD procedures, available literature data, advantages, negative aspects and the future perspectives of these modalities.

Keywords: Endoscopic ultrasound-guided biliary drainage; Malignant bile duct obstruction; Endoscopic ultrasound-guided hepaticogastrostomy; Endoscopic ultrasound-guided rendezvous technique; Endoscopic ultrasound-guided choledochoduodenostomy; Endoscopic ultrasound-guided antegrade stenting; Endoscopic retrograde cholangiopancreatography

Core Tip: Endoscopic retrograde cholangiopancreatography is the current standard of care for bile duct obstruction but is not always possible. The traditional rescue modality is percutaneous transhepatic biliary drainage which has many disadvantages. Endosonography-guided biliary drainage is a new promising interventional technique, showing many advantages over percutaneous biliary drainage and is able to fully replace it when the expertise is available. Developing new devices, training models and guidelines is expected to make this procedure easier, safe and widely accepted in the near future.