Endoscopic ultrasound-guided biliary drainage after failed endoscopic retrograde cholangiopancreatography: The road is open for almighty biliopancreatic endoscopists!

Abstract

Commentary on the article written and published by Peng et al, investigating the role of endoscopic ultrasound (EUS)-guided biliary drainage for palliation of malignant biliary obstruction after failed endoscopic retrograde cholangiopancreatography (ERCP). For 40 years endoscopic biliary drainage was synonymous with ERCP, and EUS was used mainly for diagnostic purposes. The advent of therapeutic EUS has revolutionized the field, especially with the development of a novel device such as electrocautery-enhanced lumen-apposing metal stents. Complete biliopancreatic endoscopists with both skills in ERCP and in interventional EUS, would be ideally suited to ensure patients the best drainage technique according to each individual situation.

Keywords: Cholestasis; Drainage; Electrocautery-enhanced lumen-apposing metal stents; Endoscopic ultrasound; Endosonography; Endoscopic retrograde cholangiopancreatography; Interventional procedures; Jaundice; Malignant; Biliary obstruction

Core Tip: Endoscopic retrograde cholangiopancreatography is still considered the most appropriate treatment for the management of biliary obstruction but endoscopic ultrasound-guided biliary drainage will be increasingly important in this patient population. Biliopancreatic endoscopists should master both endoscopic retrograde cholangiopancreatography and interventional endoscopic ultrasound in order to guarantee a comprehensive management of patients with biliary obstruction.