• 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

• ERCP
• EUS
• Endoscopic ultrasound
• drainage
• pancreatic duct
• pancreatico-gastrostomy
• stent

• Humans
• Drainage/methods
• Pancreatic Ducts/diagnostic imaging
• Pancreatic Ducts/surgery
• Endosonography/methods
• Ultrasonography, Interventional/methods
• Stents
• Pancreatic Diseases/surgery
• Pancreatic Diseases/diagnostic imaging
• Pancreatic Diseases/therapy
• Treatment Outcome

• endoscopic retrograde cholangiopancreatography
• endoscopic ultrasound
• endoscopic ultrasound-guided hepaticogastrostomy
• hepaticogastrostomy
• outcomes

• Choledochoduodenostomy
• ERCP
• Hepaticogastrostomy
• Lumen-apposing metal stent
• Transhepatic biliary drainage

• Humans
• Drainage/methods
• Drainage/instrumentation
• Endosonography/methods
• Ultrasonography, Interventional/methods
• Stents
• Cholangiopancreatography, Endoscopic Retrograde/methods
• Cholestasis/surgery
• Cholestasis/diagnostic imaging

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

• 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‐guided hepaticogastrostomy
• biliary drainage
• guidewire manipulation
• interventional EUS
• loop technique

• ERCP
• EUS
• EUS-guided
• Surgically altered anatomy
• biliary drainage

• EUS-guided biliary drainage
• balloon-assisted endoscopy
• benign biliary stricture
• bile duct stone
• malignant biliary obstruction

• Biliary obstruction
• Endoscopic ultrasound
• Hepaticogastrostomy
• Risk factor
• Stent

• Humans
• Retrospective Studies
• Cholestasis/etiology
• Cholestasis/surgery
• Gastrostomy/adverse effects
• Endosonography/adverse effects
• Biliary Tract Surgical Procedures/adverse effects
• Cholangiopancreatography, Endoscopic Retrograde/adverse effects
• Stents/adverse effects
• Drainage/adverse effects

• Altered anatomy
• Biliary drainage
• EUS
• Failed ERCP
• Pancreatic drainage

• endoscopic ultrasound
• endoscopic ultrasound-guided biliary drainage (EUS-BD)
• endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS)
• hepaticogastrostomy

• Drainage
• Endoscopic retrograde pancreatic bile angiography
• Endoscopic ultrasound
• Malignant obstruction of extrahepatic bile duct
• Smooth

• Aged
• Bile Ducts, Extrahepatic/diagnostic imaging
• Bile Ducts, Extrahepatic/surgery
• Cholangiopancreatography, Endoscopic Retrograde/adverse effects
• Cholangiopancreatography, Endoscopic Retrograde/methods
• Cholestasis/diagnostic imaging
• Cholestasis/etiology
• Cholestasis/surgery
• Drainage/adverse effects
• Drainage/methods
• Endosonography/methods
• Female
• Humans
• Male
• Prospective Studies
• Stents/adverse effects
• Ultrasonography, Interventional

Background: Endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) is becoming increasingly popular. However, the risk factors for stent migration into the abdominal cavity remain unknown. Methods: Forty-eight patients undergoing EUS-HGS with placement of a long, partially covered self-expandable metallic stent (LPC-SEMS) were studied retrospectively to identify risk factors of stent migration. We determined the technical and functional success rates, and recorded adverse events, including stent migration. Results: EUS-HGS was technically successful in all patients. However, stent migration was evident in five patients (one actual and four imminent, 10%). Stent migration into the abdominal cavity was observed in one patient (2%), and the other four cases required additional procedures to prevent migration (8%). Logistic regression analysis revealed that the risk of stent migration increased as the initial (pre-procedure) distance between the stomach and liver at the puncture site increased (p = 0.012). Conclusions: A longer distance between the stomach and liver at the puncture site increased the risk of stent migration. However, during EUS-HGS, it is difficult to adjust the puncture position. It is important to ensure that the proportion of the stent in the stomach is large; the use of a self-anchoring stent may be optimal.

• EUS-guided biliary drainage (EUS-BD)
• EUS-guided hepaticogastrostomy (EUS-HGS)
• interventional EUS
• obstructive jaundice
• stent migration

Endoscopic ultrasound (EUS) was originally devised as a novel diagnostic technique to enable endoscopists to stage malignancies and acquire tissue. However, it rapidly advanced toward therapeutic applications and has provided gastroenterologists with the ability to effectively treat and manage advanced diseases in a minimally invasive manner. EUS-guided biliary drainage (EUS-BD) has gained considerable attention as an approach to provide relief in malignant and benign biliary obstruction for patients when endoscopic retrograde cholangiopancreatography (ERCP) fails or is not feasible. Such instances occur in those with surgically altered anatomy, gastroduodenal obstruction, periampullary diverticulum or prior transampullary duodenal stenting. While ERCP remains the gold standard, a multitude of studies are showing that EUS-BD can be used as an alternative modality even in patients who could successfully undergo ERCP. This review will shed light on recent EUS-guided advancements and techniques in malignant and benign biliary obstruction.

• biliary obstruction
• diagnostic and therapeutic endoscopy
• endoscopic retrograde pancreatography
• endoscopic ultrasonography
• stents

• Gastroenterostomy
• Gastrointestinal tract
• Gastrojejunostomy
• Stenoses
• Stents

• Endoscopy
• Endoscopy, Gastrointestinal
• Enteral Nutrition
• Gastrostomy
• Humans
• Jejunostomy
• Palliative Care

This study aimed to evaluate the feasibility of endoscopic ultrasound (EUS)‐guided antegrade covered stent placement with long duodenal extension (EASL) for malignant distal biliary obstruction (MDBO) with duodenal obstruction (DO) or surgically altered anatomy (SAA) after failed endoscopic retrograde cholangiopancreatography (ERCP).

Outcomes were technical and clinical success, reintervention rate, adverse events, stent patency, and overall survival. Inverse probability of treatment weighting (IPTW) and competing‐risk analysis were performed to compare with conventional EUS‐BD.

Twenty‐five patients (DO, n = 18; SAA, n = 7) were included. The technical and clinical success rates were 96% and 84%, respectively. Reintervention occurred in two patients (8.3%). Adverse events occurred in six patients (24%; two cholangitis, 16%; four mild postprocedural pancreatitis [24% (n = 4/17) in patients with non‐pancreatic cancers]). The median patency was 9.4 months, and the overall survival was 2.73 months. After IPTW adjustment, the median patency in the EASL (n = 25) and conventional EUS‐BD (n = 29) were 10.1 and 6.5 months, respectively (P = .018).

EASL has acceptable clinical outcomes with a low reintervention rate but higher rate of postprocedural pancreatitis in patients with non‐pancreatic cancers. Randomized trials comparing EASL and conventional EUS‐BD for MDBO with pancreatic cancers and DO/SAA after failed ERCP are needed to validate our findings.

• EUS-guided biliary drainage
• Endoscopic ultrasound
• duodenal obstruction
• malignant biliary obstruction
• surgically altered anatomy

Endoscopic retrograde cholangiopancreatography (ERCP) is considered to be the gold standard for diagnosis and interventions in biliopancreatic diseases. However, ERCP in patients with surgically altered anatomy (SAA) appears to be more difficult compared to cases with normal anatomy. Since the production of a balloon enteroscope (BE) for small intestine disorders, BE had also been used for biliopancreatic diseases in patients with SAA. Since the development of BE-assisted ERCP, the outcomes of procedures, such as stone extraction or drainage, have been reported as favorable. Recently, an interventional endoscopic ultrasound (EUS), such as EUS-guided biliary drainage (EUS-BD), has been developed and is available mainly for patients with difficult cases of ERCP. It is a good option for patients with SAA. The effectiveness of interventional EUS for patients with SAA has been reported. Both BE-assisted ERCP and interventional EUS have advantages and disadvantages. The choice of procedure should be individualized to the patient’s condition or the expertise of the endoscopists. The aim of this review article is to discuss recent advances in interventional ERCP and EUS for patients with SAA.

• ERCP
• EUS
• EUS-BD
• altered anatomy
• balloon enteroscope
• double balloon enteroscopy
• endoscopic retrograde cholangiopancreatography
• endoscopic ultrasound
• interventional EUS
• single balloon enteroscopy

Most patients who require biliary drainage can be treated by endoscopic retrograde cholangiopancreatography (ERCP)-guided procedures. However, ERCP can be challenging in patients with complications, such as malignant duodenal obstruction, or a surgically-altered anatomy, such as a Roux-en-Y anastomosis, which prevent advancement of the duodenoscope into the ampulla of Vater. Recently, endoscopic ultrasound (EUS)-guided biliary drainage via transhepatic or transduodenal approaches has emerged as an alternative means of biliary drainage. Typically, EUS-guided gallbladder drainage or choledochoduodenostomy can be performed via both approaches, as can EUS-guided hepaticogastrostomy (HGS). EUS-HGS, because of its transgastric approach, can be performed in patients with malignant duodenal obstruction. Technical tips for EUS-HGS have reached maturity due to device and technical developments. Although the technical success rates of EUS-HGS are high, the rate of adverse events is not low, with stent migration still being reported despite many preventive efforts. In this review, we described technical tips for EUS-HGS related to bile duct puncture, guidewire insertion, fistula dilation, and stent deployment, along with a literature review. Additionally, we provided technical tips to improve the technical success of EUS-HGS.

• Drainage
• Endoscopic retrograde cholangiopancreatography
• Endoscopic ultrasound
• Endoscopic ultrasound-guided biliary drainage

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

Endoscopic ultrasound (EUS)-guided interventions provide easy access to structures adjacent to the gastrointestinal tract, effectively targeting them for therapeutic purposes. They play an important role in the management of pancreatic fluid collections (PFC) and bile duct (BD) and pancreatic duct (PD) drainage in cases of failed endoscopic retrograde cholangiopancreatography (ERCP) or gallbladder (GB) drainage. Specially designed stents and delivery systems for EUS-guided transluminal interventions allow various new applications and improve the efficacy and safety of these procedures. In fact, EUS-guided drainage has emerged as the treatment of choice for the management of PFC, and recent innovations such as fully covered metal stents (including lumen-apposing metal stents) have improved outcomes in patients with walled-off necrosis. Similarly, EUS-guided BD and PD drainage with specially designed stents can be beneficial for patients with failed ERCP due to an inaccessible papilla, gastric outlet obstruction, or surgically altered anatomy. EUS-guided GB drainage is also performed using dedicated stents in patients with acute cholecystitis who are not fit for surgery. Although the field of dedicated stents for interventional EUS is rapidly advancing with increasing innovations, the debate on the most appropriate stent for EUS-guided drainage has resurfaced. Furthermore, some important questions remain unaddressed, such as which stent improves clinical outcomes and safety in EUS-guided drainage. Herein, the current status and problems of the available stents are reviewed, including the applicable indications, long-term clinical outcomes, comparison between each stent, and their future prospects.

• drainage
• endoscopic ultrasound
• intervention
• stents
• therapeutic

• EUS-AG
• EUS-HGS
• Intrahepatic EUS-BD
• Malignant biliary obstruction
• Randomised controlled trial

• Cholestasis/diagnostic imaging
• Cholestasis/etiology
• Cholestasis/surgery
• Drainage
• Endosonography
• Humans
• Multicenter Studies as Topic
• Prospective Studies
• Randomized Controlled Trials as Topic
• Stents
• Ultrasonography, Interventional

• 81900601 National Natural Science Foundation of China
• 201702 Shengjing Free Researcher Project Foundation
• 207541024 Natural Science Foundation of Liaoning Province

• Biliary drainage
• Biliary obstruction
• Choledochoduodenostomy
• Endoscopic ultrasound
• Gallbladder drainage
• Hepaticogastrostomy
• Rendez-vous technique

• AUC
• Appropriate Use Criteria
• Appropriateness Criteria
• Benign
• Biliary
• Endoscopic
• Malignant
• Obstruction
• Percutaneous

• EUS
• EUS-guided biliary drainage
• endoscopic ultrasound
• interventional EUS
• surgically altered anatomy

• Biliary drainage
• Biliary obstruction
• ERCP
• EUS guided
• jaundice

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

ERCP is the mainstay of therapy for pancreatobiliary diseases in patients with native upper gastrointestinal (UGI) anatomy. However, when UGI anatomy is surgically altered, standard ERCP becomes technically challenging or not possible. In such instances, EUS-guided biliary drainage (EUS-BD) has been increasingly employed by advanced endoscopists as a safe and effective method of access to the biliary tree. In this study, we review the technical aspects and outcomes of EUS-BD in patients with surgical UGI anatomy.

• Advanced endoscopy
• ERCP
• EUS
• Roux-en-Y gastric bypass
• advanced endoscopy
• bariatric surgery
• biliary access
• biliary stones
• cholangiography
• new technologies
• surgically altered anatomy

• Adverse event
• EUS
• hepaticogastrostomy

• Biliary obstruction
• Cholangiopancreatography
• Endoscopy
• Pancreatic neoplasms
• Stents
• endoscopic retrograde

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