Endoscopic ultrasonography guided drainage: Summary of consortium meeting, May 21, 2012, San Diego, California

Table 1 Studies on extrahepatic endoscopic ultrasound-guided biliary drainage

Ref.	No./total sample	Method	Disease	Approach	Initial stent	Percent success rate	Complications
Giovannini et al[27] (2001)	1/1	Direct (1)	Malignant (1)	Duodenum	PS (1)	100	None
Burmester et al[6] (2003)	3/4	Direct (4)	Malignant (4)	Duodenum (2), stomach (1), jejunum (1)	PS (3)	75	Bile leak (1)
Mallery et al[28] (2004)	2/2	Rendez-vous (2)	Malignant (2)	Duodenum (2)	MS (2)	100	None
Lai and Freeman[29] (2005)	1/1	Rendez-vous (1)	Malignant (1)	Duodenum (1)	MS (1)	100	None
Püspök et al[13] (2005)	5/5	Direct (5)	Malignant (4), benign (1)	Duodenum (5)	PS (5)	80	Subacute phlegmonous cholecystitis (1)
Kahaleh et al[3] (2006)	10/23	Direct (2), rendez-vous (7)	Malignant (8), benign (2)	Duodenum (5), jejunum (5)	PS (4), MS (5)	90	Bile leak (1), pneumoperitoneum (2)
Yamao et al[20] (2006)	2/2	Direct (2)	Malignant (2)	Duodenum (2)	PS (2)	100	None
Ang et al[4] (2007)	2/2	Direct (2)	Malignant (2)	Duodenum (2)	PS (2)	100	None
Fujita et al[30] (2007)	1/1	Direct (1)	Malignant (1)	Duodenum (1)	PS (1)	100	None
Will et al[31] (2007)	8/8	Direct (8)	Malignant (7), benign (1)	Stomach (4), jejunum (3), esophagus (1)	PS (2), MS (5)	88	Slight pain (2), cholangitis (1)
Yamao et al[21] (2008)	3/3	Direct (3)	Malignant (3)	Duodenum (3)	PS (3)	100	Pneumoperitoneum (1)
Tarantino et al[19] (2008)	8/8	Direct (4), Rendez-vous (4)	Malignant (7), benign (1)	Duodenum (8)	PS (8)	100	None
Itoi et al[32] (2008)	4/4	direct (4)	Malignant (4)	Duodenum (4)	PS (3), NBD (1)	100	Focal peritonitis (1), bleeding (1)
Brauer et al[33] (2009)	12/12	Direct (4), Rendez-vous (7)	Malignant (8), benign (4)	NA	PS (5), SEMS (5)	92	Pneumoperitoneum (1), respiratory failure (1)
Horaguchi et al[14] (2009)	9/16	NA	Malignant (9)	Duodenum (8), stomach (1)	PS (14), plastic PT (1), NBT (1)	100	Peritonitis (1)
Hanada et al[17] (2009)	4/4	Direct (4)	Malignant (4)	Duodenum (4)	PS (4)	100	None
Maranki et al[34] (2009)	14/49	Direct (6), Rendez-vous (8)	Malignant (9), benign (5)	NA	NA	86	Biliary peritonitis (1), abdominal pain (1), pneumoperitoneum (1)
Kim et al[35] (2010)	15/15	Rendez-vous (15)	Malignant (10), benign (5)	Duodenum (15)	PS (4), MS (8)	80	Pancreatitis (1)
Nguyen-Tang et al[36] (2010)	1/5	Rendez-vous (1)	Malignant (1)	NA	MS (1)	100	None
Iwamuro et al[37] (2010)	7/7	Direct (7)	Malignant (7)	Duodenum (5), stomach (2)	PS (7)	100	Bile peritonitis (2)
Artifon et al[38] (2010)	3/3	Direct (3)	Malignant (3)	Duodenum (3)	MS (3)	100	None
Belletrutti et al[39] (2010)	1/1	Direct (1)	Malignant (1)	Duodenum (1)	MS (1)	100	None
Park do et al[40] (2011)	31/57	Direct (31)	Malignant (51), benign (6)	Duodenum (31)	PS (6), MS (25)	87	Pneumoperitoneum (6), mild bleeding (2)
Fabbri et al[41] (2011)	16/16	Direct (13), Rendez-vous (3)	Malignant (16)	Duodenum (15), stomach (1)	PS (4), MS (8)	80	Pancreatitis (1)
Hara et al[42] (2011)	18/18	Direct (18)	Malignant (18	NA	PS (17)	94	Peritonitis (2), bleeding (1)
Ramírez-Luna et al[43] (2011)	9/11	Direct (9)	Malignant (9)	Duodenum (9)	plastic DPT (9)	89	Biloma (1)
Siddiqui et al[44] (2011)	8/8	Direct (8)	Malignant (8)	Duodenum (80	MS (8)	100	Stent migration (1), duodenal perforation (1)
Komaki et al[45] (2011)	15/15	Direct (14), Rendez-vous (1)	Malignant (15)	Duodenum (15)	PS (15)	100	None
Prachayakul et al[46] (2011)	1/1	Direct (1)	Malignant (1)	Duodenum (1)	PS (1)	100	None
Artifon et al[22] (2012)	13/13	Direct (13)	Malignant (13)	Duodenum (13)	MS (13)	100	Bile leak (1), bleeding (1)
Attasaranya et al[47] (2012)	10/31	Direct (9), Antegrade (1)	Malignant (23), benign (8)	Duodenum	NA	60	4/10 (40%)
Katanuma et al[48] (2012)	1/1	Direct (1)	Benign (1)	Duodenum (1)	PS (1)	100	None
Kawakubo et al[49] (2012)	2/2	Direct (2)	Malignant (2)	Duodenum (2)	PS (2)	100	None
Khashab et al[50] (2012)	7/9	Direct (2), antegrade (2), Rendez-vous (3)	Malignant (7)	Duodenum (6), gastric (1)	MS (7)	100	Pancreatitis (1), cholecystitis (1), abdominal pain (1)
Kim et al[51] (2012)	9/13	Direct (9)	Malignant (9)	Duodenum (9)	MS (9)	100	Pneumoperitoneum (2), migration (2), peritonitis (1)
Song et al[52] (2012)	15/15	Direct (15)	Malignant (15)	Duodenum (15)	MS (15)	100	Pneumoperitoneum (2), cholangitis (1)
Dhir et al[53] (2012)	58/58	Rendez-vous (58)	Malignant (43), benign (15)	Duodenum (58)	NA	98	Bile leak (2)
Hara et al[54] (2013)	18/18	Direct (18)	Malignant (18)	Duodenum (18)	MS (18)	94	Bile peritonitis (2)
Park do et al [55] (2013)	16/45	Direct (2), Rendez-Vous (14)	Malignant (39), benign (6)	Duodenum (16)	MS (16)	88	Pancreatitis (1), bile peritonitis (1)
Itoi et al [56] (2013)	1/1	Direct (1)	Malignant (1)	Stomach (1)	MS (1)	100	None
Total	365					338/365 (93%)	58/365 (16%)

Table 2 Studies on intrahepatic endoscopic ultrasound-guided biliary drainage

Ref.	No./total sample	Method	Disease	Approach	Initial stent	Percent success rate	Complications
Burmester et al[6] (2003)	1/4	Direct (1)	Malignant (1)	Stomach (1)	PS (1)	100	Bile leak (1)
Püspök et al[13] (2005)	1/1	Direct (1)	Malignant (1)	jejunum (1)	PS (1), MS (1)	100	None
Kahaleh et al[3] (2006)	13/23	Direct (1), Rendez-vous (12)	Malignant (9), benign (4)	Stomach (13)	PS (6), MS (6)	92	Minor bleeding (1)
Bories et al[16] (2007)	11/11	Direct (9), Antegrade (2)	Malignant (3), benign (8)	Stomach (3), Duodenum (3), stenosis (5)	PS (7), MS (3)	91	Transient ileus (1), biloma (1), cholangitis (1)
Horaguchi et al[14] (2009)	7/16	NA	Malignant (7)	Stomach (5), esophagus (2)	PS (2), MS (5)	100	None
Maranki et al[34] (2009)	35/49	Direct (9), Antegrade (24)	Malignant (26), benign (9)	NA	NA	83	Bleeding (1), pneumoperitoneum (3), aspiration pneumonia (1)
Nguyen-Tang et al[36] (2010)	4/5	Rendez-vous (4)	Malignant (3), benign (1)	Duodenum (1), Stomach (3)	MS (5)	100	None
Park do et al[40] (2011)	31/57	Direct (31)	Malignant (51), benign (6)	Duodenum (31)	PS (6) MS (25)	87	Pneumoperitoneum (1), bile peritonitis (2)
Ramírez-Luna et al[43] (2011)	2/11	Direct (2)	Malignant (2)	Stomach (2)	PS (2)	100	Stent migration (1)
Attasaranya et al[47] (2012)	16/31	Direct (16)	Malignant (23), benign (8)	NA	NA	81	6/16 (38%)
Khashab et al[50] (2012)	2/9	Antegrade (1), rendez-vous (1)	Malignant (2)	Stomach	MS (2)	100	Nausea (1)
Kim et al[51] (2012)	4/13	Direct (4)	Malignant (4)	Stomach (4)	MS (3)	75	Peritonitis (1), stent migration (1)
Park do et al[55] (2013)	29/45	Direct (9), antegrade (14), rendez-vous (5)	Malignant (39), benign (6)	Stomach (29)	NA	66	Biloma (1)
Iwashita et al[57] (2013)	6/6	Direct (1)	Malignant (1), benign (5)	NA	MS (1)	100	Pancreatitis (1), abdominal pain (1)
Total	162					136/162 (84%)	26/162 (16%)

Table 3 Studies on endoscopic ultrasound-guided pancreatico-gastrostomy

Ref.	NB PTS	Success	Complication	Follow-up
Tessier et al[24] (2007)	36	70%	11%	16.5 mo
Kahaleh et al[3] (2006)	13	92%	16%	14 mo
Barkay et al[25] (2010)	21	48%	2%	13 mo
Ergun et al[26] (2011)	20	90%	10%	37 mo

Table 4 Summary of published data on endoscopic ultrasound-guided gallbladder drainage

Ref.	No. of cases	Device for puncture	Approach route	Technical success	Clinical success	Stent	Complication (No. of cases)
Baron et al[70] (2007)	1	19 G FN	TD	100%	100%	7F PS	None
Kwan et al[71] (2007)	3	19 G FN/FT/CT	TD	100%	100%	8.5F NBD	Bile leakage (1)
Lee et al[72] (2007)	9	19 G FN	TD	100%	100%	5F NBD	Pneumoperitoneum (1)1
Kamata et al[74] (2009)	1	19 G FN	TG	100%	100%	7F PS	None
Takasawa et al[73] (2009)	1	NK	TG	100%	100%	7F PS	None
Song et al[75] (2010)	8	19 G FN +/- NK	1TG/7TD	100%	100%	7F PS	Bile Leakage (1), pneumoperitoneum (1), stent migration (1)
Súbtil et al[81] (2010)	4	CT/NK	TG	100%	100%	8.5F PS	None
Jang et al[77] (2011)	15	19 G FN/NK	10TG/5TD	100%	100%	New SEMS	Pneumoperitoneum (2)
Jang et al[79] (2012)	30	19 G FN/NK	TG/TD	97%	100%	5F NBD	Pneumoperitoneum (2)
Itoi et al[78] (2012)	5	19 G FN/1 CT	1TG/4TD	100%	100%	New SEMS	Mild bleeding (1)
de la Serna-Higuera et al[80] (2013)	13	CT	12TG/1TD	84.6%	100%	New SEMS	Hematochezia (1/11), pain (1/11)

¹Minor bile leakage without serious bile peritonitis. G: Gauge; NK: Needle knife; FT: Fistulotome; CT: Cystotome; PS: Plastic stent; NBD: Naso-Gallbladder Drain; TD: TransDuodenal; Approach TG: TransGastric approach; Partially covered SEMS: Partially cover self expandable metallic stent.

Table 5 Outcomes of biliary drainage in endosonographic cholangiopancreatography series including surgically altered anatomy patients n (%)

Ref.	n	Patients with SAA	Overall technical success	Type of ESCP drainage				Complications
				Transpapillary		Transmural
				RV	AG	HG	CD
Will et al[31] (2007)	8	7 (87)	7 (87)	1	-	6	-	2 (25)
Bories et al[16] (2007)	11	4 (36)	10 (91)	-	-	10	-	4 (36)
Horaguchi et al[14] (2009)	16	4 (25)	16 (100)	-	-	8	8	2 (12)
Maranki et al[34] (2009)	49	7 (14)	41 (84)	201	141	3	4	8 (16)
Shah et al[106] (2012)	68	19 (28)	58 (85)	392	102	8	1	6 (9)
Iwashita et al[118] (2012)	40	9 (40)	29 (73)	29	-	-	-	5 (13)
Park et al[55] (2013)	45	14 (31)	41 (95)	16	9	14	2	5 (11)
Total	237	64 (27)	202 (85)	105	33	49	15	32 (13)
				138 (68)		64 (32)

¹Not specified in the original report, data provided by the author;

²Not specified in the original report. Data estimated from prior detailed series[48]. SAA: Surgically altered anatomy; ESCP: Endosonographic cholangiopancreatography; RV: Rendezvous; AG: Antegrade; HG: Hepatico-gastrostomy; CD: Choledochoduodenostomy.

Table 6 Patients with malignant biliary obstruction and surgically altered anatomy drained by endosonographic cholangiopancreatography

Ref.	No. ofpatients1	Type of SAA				Etiology			Type of ESCP drainage2				Success/complex4
									Transpapillary		Transmural
		RYG	RYHJ	PD	Other	Gast	Panc	Other	RV	AG	HG	Other3	Sn	Cn
Burmester et al[6] (2003)	2/4	1	-	-	1	1	1	-	-	-	1 (0)	1 (0)	2/2	0
Giovannini et al[2] (2003)	1/1	1	-	-	-	1	-	-	-	-	1 (1)5	-	1/1	0
Püspök et al[13] (2005)	1/6	1	-	-	-	1	-	-	-	1 (1)	-	1 (0)6	1/1	0
Kahaleh et al[3] (2006)	2/23	-	-	-	2	-	1	1	2 (1)	-	-	-	2/2	0
Will et al[31] (2007)	6/8	4	1	1	-	4	-	2	-	-	3 (3)	3 (1)	5/6	2
Bories et al[16] (2007)	1/11	-	-	1	-	-	1	-	-	-	1 (0)	-	1/1	0
Horaguchi et al[14] (2009)	4/16	-	2	-	2	1	1	2	-	-	2 (2)5	2 (1)5	4/4	1
Chopin-Laly et al[115] (2009)	1/1	-	-	-	1	-	1	-	-	-	1 (1)	-	1/1	0
Nguyen-Tang et al[36] (2010)	1/5	-	1	-	-	-	-	1	-	1 (1)	-	-	1/1	0
Ma et al[117] (2011)	1/1	-	-	1	-	-	-	1	-	-	1 (0)	-	1/1	0
Henry et al[116] (2011)	1/1	-	-	-	1	-	-	1	-	-	-	1 (0)7	1/1	1
Iwashita et al[118] (2012)	1/7	1	-	-	-	1	-	-	-	1 (1)	-	-	1/1	1
Total	22	8	4	3	7		5	8	2 (1)	3 (3)	10 (7)	7 (1)
		22				9 (40%)	13 (60%)		5 (23%)		17 (77%)		21 (95%)	5 (23%)

¹Number of surgically altered anatomy (SAA) patients with malignant biliary obstruction per total number of patients in the series;

²Number of patients with attempted stent placement (ITT), followed by number of metal stents in parentheses;

³Transmural variants of HG (hepatico-esophagostomy/jejunostomy) following intrahepatic access, except when stated otherwise;

⁴Number of successful cases or complications per number of SAA patients with malignant biliary obstruction;

⁵Initial plastic stent replaced at follow-up. Only final stent tallied in the total count;

⁶Additional hepato-esophageal plastic stent combined with AG metal stent in recurrent gastric cancer after RYG. Not tallied in the total count;

⁷Choledochoduodenostomy after palliative gastrojejunostomy. SAA: Surgically altered anatomy; ESCP: Endosonographic cholangiopancreatography; RYG: Roux-en-Y gastrectomy; RYHJ: Roux-en-Y hepatico-jejunostomy; PD: Pancreatico-duodenectomy; Gast: Gastric; Panc: Pancreatic; RV: Rendezvous; AG: Antegrade; HG: Hepatico-gastrostomy; ITT: Intention-to-treat; Sn: Successful cases; Cn: Complications.

Table 7 Patients with benign biliary obstruction and surgically altered anatomy drained by endosonographic cholangiopancreatography

Ref.	No. of patients1	Type of SAA				Etiology		Type of ESCP drainage					Success/complex5
								Transpapillary2			Transmural3
		RYG	RYGB	RYHJ	Other	Stone	Strx	RV	AGS	AGB	HG	Other4	Sn	Cn
Püspök et al[13] (2005)	1/6	-	-	-	1	1	-	-	-	-	-	1 (0)6	1/1	0
Kahaleh et al[3] (2006)	2/23	-	-	1	1	1	1	2	-	-	-	-	1/2	1
Will et al[31] (2007)	1/8	-	-	1	-	-	1	17	-	-	-	1 (0)	1/1	0
Bories et al[16] (2007)	3/11	-	-	-	3	-	3	17	-	-	3 (1)	-	2/3	1
Weilert et al[110] (2011)	6/6	-	6	-	-	6	-	2	-	4	-	-	6/6	1
Artifon et al[112] (2011)	1/1	-	-	1	-	-	1	-	1	19	-	-	1/1	0
Park et al[113] (2012)	1/1	-	-	1	-	-	1	-	-	1	-	-	1/1	0
Bapaye et al[114] (2012)	1/1	-	-	1	-	-	1	-	-	1	-	-	1/1	0
Iwashita et al[57] (2013)	6/7	4	-	-	2	5	1	-	-	59	-	-	6/6	1
Park et al[109] (2013)	3/6	-	-	3	-	-	3	-	1	38	-	-	2/3	0
Total	25	4	6	8	7			6	2	13	3 (1)	2 (0)
		25				13 (52%)	12 (48%)	21 (84%)			5 (20%)		22 (88%)	4 (16%)

¹Number of surgically altered anatomy (SAA) patients with benign biliary obstruction per total number of patients in the series; ²Number of patients with attempted drainage by stent insertion and/or balloon dilation with/without stone removal (ITT); ³Number of patients with attempted stent placement (ITT), followed by number of metal stents in parentheses;

⁴Transmural variants of HG (hepatico-esophagostomy/jejunostomy) following intrahepatic access, except when stated otherwise;

⁵Number of successful cases or complications per number of SAA patients with benign biliary obstruction;

⁶Choledochoduodenostomy with plastic stents used for transmural stone extraction in Billroth I;

⁷Transpapillary AG metal stent placed at follow-up of prior transmural intrahepatic stenting in anastomotic Strx. Tallied in the total count;

⁸AGB prior to AGS in a single case. AGS tallied as main intervention and AGB not tallied in the total count;

⁹AGB with stone removal plus temporary NBD placement in four patients. AGB of anastomotic Strx and normal cholangiogram in one each. SAA: Surgically altered anatomy; ESCP: Endosonographic cholangiopancreatography; RYG: Roux-en-Y gastrectomy; RYGB: Roux-en-Y gastric bypass; RYHJ: Roux-en-Y hepatico-jejunostomy; RV: Rendezvous; AGS: Antegrade stent insertion; AGB: Antegrade balloon dilation; HG: Hepatico-gastrostomy; ITT: Intention-to-treat; Sn: Successful cases; Cn: Complications.