Razpotnik M. Redefining endoluminal biliary drainage: Challenges and innovations in endosonography-guided techniques. World J Gastroenterol 2025; 31(1): 99951 [DOI: 10.3748/wjg.v31.i1.99951]
Corresponding Author of This Article
Marcel Razpotnik, MD, Department of Gastroenterology and Hepatology, Charité Berlin, Charitépl 1, Berlin 10117, Germany. marcel.razpotnik@gmail.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Letter to the Editor
Open-Access Policy of This Article
This article is an open-access article which 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: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastroenterol. Jan 7, 2025; 31(1): 99951 Published online Jan 7, 2025. doi: 10.3748/wjg.v31.i1.99951
Redefining endoluminal biliary drainage: Challenges and innovations in endosonography-guided techniques
Marcel Razpotnik
Marcel Razpotnik, Department of Gastroenterology and Hepatology, Campus Virchow/Campus Mitte, Charité Berlin, Berlin 10117, Germany
Author contributions: Razpotnik M contributed to the conception, drafting, and final approval of the manuscript; Razpotnik M is responsible for all aspects of the work and has read and approved the final manuscript.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
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 NonCommercial (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: Marcel Razpotnik, MD, Department of Gastroenterology and Hepatology, Charité Berlin, Charitépl 1, Berlin 10117, Germany. marcel.razpotnik@gmail.com
Received: August 3, 2024 Revised: October 17, 2024 Accepted: November 11, 2024 Published online: January 7, 2025 Processing time: 127 Days and 17.4 Hours
Abstract
Endoscopic retrograde cholangiopancreatography is considered the gold standard for treating benign and malignant biliary obstructions. However, its use in complex biliary obstructions is limited. Over the past decades, therapeutic endosonography (EUS) and emerging technologies such as lumen-apposing metal stents have enabled endoscopic treatment of conditions previously requiring non-endoscopic or surgical approaches. Studies show that EUS-guided choledochoduodenostomy is a reliable alternative to endoscopic retrograde cholangiopancreatography in the treatment of distal malignant biliary obstructions and can be considered a primary drainage modality in centers with adequate expertise. For malignant hilar biliary obstructions, draining at least 50% of viable liver tissue often requires combining different modalities. The treatment strategy in these patients should be individualized, depending on the Bismuth classification, patient physical status, and intended systemic therapy. Due to the lack of evidence, general recommendations cannot be made for EUS-guided hepaticoduodenostomy or combined procedures with transhepatic bridging stents. These novel techniques should be limited to selected palliative cases where conventional methods have failed and conducted within clinical trials to generate evidence before broader application.
Core Tip: The latest developments in endoscopic techniques have revolutionized the management of benign and malignant biliary obstructions. Studies have demonstrated that endosonography (EUS)-guided choledochoduodenostomy is a reliable alternative to endoscopic retrograde cholangiopancreatography and can be considered a primary drainage modality in centers with adequate expertise. In malignant hilar biliary obstructions, drainage of at least 50% of viable liver often requires a combination of different modalities. This manuscript examines novel multimodal approaches, including EUS-guided hepaticogastrostomy and hepaticoduodenostomy, as well as innovative techniques such as additional transhepatic bridging stents, which need further validation before broader clinical application. Current trends emphasize personalized treatment strategies, increasingly incorporating EUS-guided and hybrid approaches in biliary obstruction management.
