Published online Jan 21, 2016. doi: 10.3748/wjg.v22.i3.1297
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
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.
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.