• cannulation
• double guidewire
• endoscopic retrograde cholangiopancreatography
• endoscopic ultrasound‐guided biliary drainage
• precut

• Humans
• Bile Ducts/anatomy & histology
• Bile Ducts/diagnostic imaging
• Biliary Tract Diseases/diagnostic imaging
• Biliary Tract Diseases/surgery
• Catheterization/adverse effects
• Catheterization/methods
• Cholangiopancreatography, Endoscopic Retrograde/adverse effects
• Cholangiopancreatography, Endoscopic Retrograde/methods
• Endosonography/adverse effects
• Endosonography/methods
• Ultrasonography, Interventional/adverse effects
• Ultrasonography, Interventional/methods

• Biliopancreatic diseases
• biliary rendezvous
• endoscopic retrograde cholangiopancreatography
• endoscopy
• endosonography

• Humans
• Male
• Female
• Retrospective Studies
• Endosonography/methods
• Endosonography/adverse effects
• Middle Aged
• Aged
• Tertiary Care Centers
• Drainage/methods
• Drainage/adverse effects
• Cholangiopancreatography, Endoscopic Retrograde/methods
• Cholangiopancreatography, Endoscopic Retrograde/adverse effects
• Catheterization/methods
• Catheterization/adverse effects
• Biliary Tract Diseases/diagnostic imaging
• Pancreatic Diseases/diagnostic imaging
• Ultrasonography, Interventional/methods
• Treatment Outcome

• Humans
• Brazil
• Consensus
• Drainage/methods
• Endosonography/methods
• Endosonography/standards
• Liver Diseases/diagnostic imaging
• Liver Diseases/pathology
• Pancreatic Diseases/diagnostic imaging
• Pancreatic Diseases/pathology
• Review Literature as Topic

• acute cholecystitis
• endoscopic
• endoscopic retrograde cholangiopancreatography
• endoscopic ultrasound
• endoscopic ultrasound-guided gallbladder drainage
• obstructive jaundice
• ultrasound-guided biliary drainage

• endoscopic ultrasound-guided biliary drainage
• endoscopic ultrasound-guided hepaticogastrostomy
• endoscopic ultrasound-guided rendezvous
• pneumoperitoneum
• stent

• biliary cannulation
• endoscopic retrograde cholangiography
• endosonography
• interventional radiology

• Humans
• Cholangiopancreatography, Endoscopic Retrograde/methods
• Bile Ducts/diagnostic imaging
• Bile Ducts/surgery
• Endosonography/methods
• Drainage/methods
• Ultrasonography, Interventional
• Cholestasis/etiology

• Humans
• Cholestasis/etiology
• Cholestasis/surgery
• Endosonography/adverse effects
• Cholangitis
• Drainage/adverse effects
• Stents/adverse effects
• Cholangiopancreatography, Endoscopic Retrograde/adverse effects

• EUS-BD
• EUS-GEA
• GOO
• LAMS
• MBO
• biliary obstruction
• cancer
• endoscopic ultrasound
• endoscopy
• gastric outlet obstruction
• gastroenteroanastomosis
• gastrojejunostomy
• pancreas

• Ricerca corrente 2023 Italian Health ministry

Familial adenomatous polyposis (FAP) patients with Spigelman stage IV polyposis should be considered for prophylactic duodenectomy. Post‐surgical pancreaticobiliary complications occur and may require management via endoscopic retrograde cholangiopancreatography (ERCP). We aimed to assess the success and adverse events of ERCP in FAP patients after pancreas‐sparing duodenectomy (PSD) and pancreaticoduodenectomy (PD).

A retrospective review of FAP patients who underwent ERCP after PSD or PD from 1992 to 2020 at a quaternary referral center was completed. The technical success of ERCP was defined as the ability to identify the anastomosis and cannulate the duct. Post‐procedural adverse events were defined by bleeding, perforation, pancreatitis, or cholangitis. Clinical outcomes included the need for surgical intervention and recurrent pancreatitis after ERCP were assessed.

Of 84 FAP patients with duodenectomy, 12 patients with PSD and two patients with PD underwent 17 ERCPs for pancreatic indications and five for biliary indications. The technical success of ERCP in patients with PSD and a single neoampullary complex for pancreatic (n = 6) and biliary (n = 5) indications was 100% but for those with PD (n = 2) or PSD reconstruction with pancreatic divisum or separate anastomoses (n = 3), it was 0%. Surgical intervention was required in 50% of patients with technically failed ERCP after PSD (2/4) and PD (1/2). There were no adverse events.

ERCP is expected to be therapeutically successful for biliary complications following PSD. Assessment and potential therapy for pancreatitis post‐PSD are best in the setting of a single neo‐ampullary complex rather than in PD or PSD with pancreatic divisum.

• Cholangiopancreatography, Endoscopic Retrograde/methods
• Drainage/methods
• Endoscopy, Gastrointestinal/methods
• Endosonography
• Humans
• Self Expandable Metallic Stents

• Biliary Tract Surgical Procedures
• Cholangiopancreatography, Endoscopic Retrograde/methods
• Drainage/methods
• Endoscopy, Gastrointestinal/methods
• Endosonography
• Humans

• Biliary obstruction
• EUS-guided biliary drainage (EUS-BD)
• EUS-guided gallbladder drainage (EUS-GBD)
• Endoscopic ultrasound (EUS)
• Portal hypertension

• Biliary Tract Neoplasms
• Cholangiopancreatography, Endoscopic Retrograde
• Cholestasis/diagnostic imaging
• Cholestasis/etiology
• Cholestasis/therapy
• Drainage
• Endosonography
• Humans

• 22-gauge
• antegrade treatment
• endoscopic ultrasound
• hepaticogastrostomy
• tapered

• EUS
• biliary drainage
• hilar biliary obstruction
• neoplasms

• algorithm
• biliary cannulation
• endoscopic retrograde cholangiopancreatography
• endoscopic ultrasound
• rendezvous

Malignant biliary obstruction (MBO) encompasses a variety of malignancies arising from the pancreaticobiliary system. This can be divided into malignant hilar biliary obstruction (MHBO) or malignant distal biliary obstruction (MDBO) biliary obstruction to which clinical outcomes and technical considerations of various biliary drainage methods may differ. EUS biliary drainage (EUS-BD) has been increasingly influential in the management of MBO together with other familiar biliary drainage methods such as ERCP and percutaneous transhepatic biliary drainage (PTBD). Conventionally, ERCP has always been the primary choice of endoscopic biliary drainage in both MHBO and MDBO and that PTBD or EUS-BD is used as a salvage method when ERCP fails for which current guidelines recommends PTBD, especially for MHBO. This review was able to show that with today's evidence, EUS-BD is equally efficacious and possesses a better safety profile in the management of MBO and should be on the forefront of endoscopic biliary drainage. Therefore, EUS-BD could be used either as a primary or preferred salvage biliary drainage method in these cases.

• ERCP
• EUS
• EUS-guided biliary drainage
• Klatskin's tumor
• endosonography
• hilar cholangiocarcinoma
• malignant distal biliary obstruction
• malignant hilar biliary obstruction
• perihilar cholangiocarcinoma

EUS-guided biliary drainage (EUS-BD) has been used as a salvage modality for relief of malignant biliary obstruction (MBO) after a failed ERCP. Multiple recent randomized controlled trials (RCTs) and observational studies have been published to assess the suitability of EUS-BD as a first-line modality for achieving palliative BD. We aimed to perform a systematic review and meta-analysis comparing primary EUS-BD versus ERCP for MBO. We searched PubMed, Medline, and Embase up to January 1, 2019, to identify RCTs and observational studies evaluating the efficacy and safety of primary EUS-BD (without a prior attempted ERCP) versus ERCP. Quality of RCTs and observational studies was assessed using Jadad and Newcastle–Ottawa scores, respectively. The outcomes of interest were technical success, clinical success, odds of requiring a repeat intervention, and procedure-related adverse events. Odds ratios (ORs) and standard mean difference were calculated for categorical and continuous variables, respectively. Meta-analysis was performed using the random effects model in RevMan 5.3 (the Cochrane Collaboration, the Nordic Cochrane Centre, Copenhagen, Denmark). Five studies (three RCTs and two observational studies) with 361 patients were included. Both procedures achieved comparable technical success (OR: 1.20 [0.44–3.24], I² = 0%) and clinical success (OR: 1.44, confidence interval [CI]: 0.63–3.29, I² = 0%). The overall adverse outcomes (OR: 1.59 [0.89–2.84]) did not differ between the two groups. In the ERCP group, 9.5% of patients developed procedure-related pancreatitis versus zero in the EUS group (risk difference = 0.08%, P = 0.02). There was no statistically significant difference in nonpancreatitis-related adverse events. The odds of requiring reintervention for BD (1.68 [0.76–3.73], I² = 42%) did not differ significantly. The ERCP group had significantly higher odds of requiring reintervention due to tumor overgrowth (5.35 [1.64–17.50], I² = 0%). EUS-BD has comparable technical and clinical success to ERCP and can potentially be used as a first-line palliative modality for MBO where expertise is available. ERCP-related pancreatitis which can cause significant morbidity can be completely avoided with EUS.

• EUS-guided biliary drainage
• malignant biliary stricture
• therapeutic EUS

• Endoscopic retrograde cholangiopancreatography
• Endoscopic ultrasound-guided biliary drainage
• Endoscopic ultrasound-guided choledochoduodenostomy
• Malignant biliary obstruction
• Percutaneous transhepatic biliary drainage

In the last years, endoscopic ultrasonography (EUS) has evolved from a purely diagnostic technique to a more and more complex interventional procedure, with the possibility to perform several type of therapeutic interventions. Among these, EUS-guided biliary drainage (BD) is gaining popularity as a therapeutic approach after failed endoscopic retrograde cholangiopancreatography in distal malignant biliary obstruction (MBO), due to the avoidance of external drainage, a lower rate of adverse events and re-interventions, and lower costs compared to percutaneous trans-hepatic BD. Initially, devices created for luminal procedures (e.g., luminal biliary stents) have been adapted to the new trans-luminal EUS-guided interventions, with predictable shortcomings in technical success, outcome and adverse events. More recently, new metal stents specifically designed for transluminal drainage, namely lumen-apposing metal stents (LAMS), have been made available for EUS-guided procedures. An electrocautery enhanced delivery system (EC-LAMS), which allows direct access of the delivery system to the target lumen, has subsequently simplified the classic multi-step procedure of EUS-guided drainages. EUS-BD using LAMS and EC-LAMS has been demonstrated effective and safe, and currently seems one of the most performing techniques for EUS-BD. In this Review, we summarize the evolution of the EUS-BD in distal MBO, focusing on the novelty of LAMS and analyzing the unresolved questions about the possible role of EUS as the first therapeutic option to achieve BD in this setting of patients.

• Interventional endoscopic ultrasonography
• Endoscopic ultrasonography-guided biliary drainage
• Endoscopic ultrasonography-guided choledocho-duodenostomy
• Biliary metal stent
• Lumen-apposing metal stent

• Cholangiopancreatography, Endoscopic Retrograde/adverse effects
• Cholangiopancreatography, Endoscopic Retrograde/instrumentation
• Cholangiopancreatography, Endoscopic Retrograde/methods
• Cholestasis/etiology
• Cholestasis/therapy
• Common Bile Duct Neoplasms/complications
• Common Bile Duct Neoplasms/pathology
• Drainage/adverse effects
• Drainage/instrumentation
• Drainage/methods
• Electrocoagulation/adverse effects
• Electrocoagulation/instrumentation
• Electrocoagulation/methods
• Endosonography/methods
• Humans
• Neoplasm Invasiveness/pathology
• Pancreatic Neoplasms/complications
• Pancreatic Neoplasms/pathology
• Self Expandable Metallic Stents
• Treatment Outcome
• Ultrasonography, Interventional/methods

Endoscopic ultrasound/ultrasonography‐guided biliary drainage (EUS‐BD) is a relatively new modality for biliary drainage after failed or difficult transpapillary biliary cannulation. Despite its clinical utility, EUS‐BD can be complicated by severe adverse events such as bleeding, perforation, and peritonitis. The aim of this paper is to provide practice guidelines for safe performance of EUS‐BD as well as safe introduction of the procedure to non‐expert centers. The guidelines comprised patient–intervention–comparison–outcome‐formatted clinical questions (CQs) and questions (Qs), which are background statements to facilitate understanding of the CQs. A literature search was performed using the PubMed and Cochrane Library databases. Statement, evidence level, and strength of recommendation were created according to the GRADE system. Four committees were organized: guideline creation, expert panelist, evaluation, and external evaluation committees. We developed 13 CQs (methods, device selection, supportive treatment, management of adverse events, education and ethics) and six Qs (definition, indication, outcomes and adverse events) with statements, evidence levels, and strengths of recommendation. The guidelines explain the technical aspects, management of adverse events, and ethics of EUS‐BD and its introduction to non‐expert institutions.

• Biliary stricture
• EUS-guided biliary drainage
• Endoscopic ultrasonography
• Interventional EUS

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.

• Endoscopic ultrasonography-guided biliary drainage
• EUS
• Percutaneous transhepatic biliary drainage
• Endoscopic ultrasonography-guided hepatogastric anastomosis
• Endoscopic ultrasonography-guided antegrade stent placement
• Endoscopic ultrasonography-guided choledochoduodenostomy
• Endoscopic ultrasonography-guided transgallbladder
• Endoscopic ultrasonography-guided rendezvous

Although endoscopic retrograde cholangiopancreatography (ERCP) is the first-line treatment for benign biliary diseases, this procedure is technically difficult in some conditions such as a surgically altered anatomy and gastric outlet obstruction. After a failed ERCP, a surgical or a percutaneous approach is selected as a rescue procedure; however, various endoscopic ultrasound (EUS)-guided interventions are increasingly utilized in pancreatobiliary diseases, including EUS-guided rendezvous for failed biliary cannulation, EUS-guided antegrade treatment for stone management, and EUS-guided hepaticogastrostomy for anastomotic strictures in patients with a surgically altered anatomy. There are some technical hurdles in EUS-guided interventions for benign biliary diseases owing to the difficulty in puncturing a relatively small bile duct and in subsequent guidewire manipulation, as well as the lack of dedicated devices. A recent major advancement in this field is the introduction of a 2-step approach, in which EUS-guided drainage is placed in the first session and antegrade treatment is performed in subsequent sessions. This approach allows the use of various techniques such as mechanical lithotripsy and cholangioscopy without a risk of bile leak. In summary, EUS-guided interventions are among the treatment options for benign biliary diseases; however, standardization of the procedure and development of a treatment algorithm are needed.

• Benign biliary diseases
• Biliary drainage
• Cholangioscopy
• Endoscopic ultrasound

Over the last decade, endoscopic ultrasound-guided biliary drainage (EUS-BD) has evolved into a widely accepted alternative to the percutaneous approach in cases of biliary obstruction with failed endoscopic retrograde cholangiopancreaticography (ERCP). The available evidence suggests that, in experienced hands, EUS-BD might even replace ERCP as the first-line procedure in specific situations such as malignant distal bile duct obstruction. The aim of this review is to summarize the available data on EUS-BD and propose an evidence-based algorithm clarifies the role of the different EUS-BD techniques in the management of benign and malignant biliary obstructive disease.

• Endoscopic ultrasound
• Endoscopic retrograde cholangiopancreaticography
• Biliary drainage
• Rendez-vous
• Hepaticogastrostomy
• Choledochoduodenostomy

• biliary cannulation
• distal common bile duct stricture
• endoscopic retrograde cholangiopancreatography
• percutaneous transhepatic gallbladder drainage
• rendezvous technique

• Consensus
• EUS-guided biliary drainage
• questionnaire survey

EUS-guided rendezvous technique (EUS-RV) is an effective salvage technique for failed biliary cannulation during ERCP. However, it is still difficult to achieve cannulation in some cases, especially using the intrahepatic bile duct (IHBD) approach, which requires complicated guidewire manipulation. EUS-hybrid rendezvous technique (HRV) has been applied as a salvage technique for difficult guidewire placement during EUS-RV with IHBD approach. The aims of this study were to evaluate the efficacy and safety of EUS-HRV using a retrospective study. Database analysis revealed 29 patients who underwent EUS-RV for difficult biliary cannulation. Among them, 8 patients underwent EUS-HRV as a salvage technique for difficult guidewire placement during EUS-RV with the IHBD approach. In EUS-HRV, a 6-French dilator was advanced into the biliary system for better guidewire manipulation. After successful guidewire placement, the EUS scope was exchanged for a duodenoscope, keeping the guidewire and dilator in place. The EUS-placed guidewire was retrieved through the duodenoscope, followed by cannulation over the guidewire. The dilator remained at the fistula until completion of the procedure. The analysis showed that the guidewire placement and the subsequent scope exchange and deep biliary cannulation after the retrieval of the EUS-placed guidewire were successfully conducted for all 8 patients. Mild pancreatitis was recognized as an adverse event in 1 patient. The overall success rate of EUS-RV combined with EUS-HRV was improved up to 90% (26/29). Our results suggested that EUS-HRV can be an effective and safe salvage technique in cases wherein guidewire placement is difficult during EUS-RV with IHBD approach.

• Aged
• Aged, 80 and over
• Bile Ducts, Intrahepatic/diagnostic imaging
• Bile Ducts, Intrahepatic/surgery
• Catheterization/adverse effects
• Catheterization/instrumentation
• Catheterization/methods
• Cholangiopancreatography, Endoscopic Retrograde/adverse effects
• Cholangiopancreatography, Endoscopic Retrograde/instrumentation
• Cholangiopancreatography, Endoscopic Retrograde/methods
• Databases, Factual
• Humans
• Male
• Middle Aged
• Retrospective Studies

• EUS-BD
• EUS-HGS
• endoscopic ultrasound

• EUS-Guided Gallbladder Drainage (EUS-GBD)
• EUS-Guided Gastroenterostomy (EUS-GE)
• EUS-Guided Pancreatic Fluid Collection Drainage (EUS-PFC Drainage)

• Benign and resectable malignant biliary disorders
• Endoscopic ultrasonography
• Endoscopic ultrasound-guided fine needle aspiration
• Endoscopic ultrasound-guided rendezvous technique
• Unsuccessful biliary cannulation