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World J Gastrointest Endosc. Oct 25, 2015; 7(15): 1181-1185
Published online Oct 25, 2015. doi: 10.4253/wjge.v7.i15.1181
Reality named endoscopic ultrasound biliary drainage
Hugo Gonçalo Guedes, Roberto Iglesias Lopes, Joel Fernandez de Oliveira, Everson Luiz de Almeida Artifon
Hugo Gonçalo Guedes, Roberto Iglesias Lopes, Department of Surgery, University of São Paulo Medical School, São Paulo 05422-090, Brazil
Joel Fernandez de Oliveira, Everson Luiz de Almeida Artifon, Division of Gastrointestinal Endoscopy, University of São Paulo Medical School, São Paulo 05422-090, Brazil
Author contributions: Guedes HG wrote the article and performed review of the literature; Lopes RI, de Oliveira JF and de Almeida Artifon EL critically revised the manuscript; final version was approved by all authors.
Conflict-of-interest statement: The authors declare that they have no competing interests.
Open-Access: 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/
Correspondence to: Roberto Iglesias Lopes, MD, PhD, Department of Surgery, University of São Paulo Medical School, Carvalho Aguiar, 255, 7 andar, São Paulo 05422-090, Brazil. robertoiglesias@terra.com.br
Telephone: +55-11-26618080
Received: April 30, 2015
Peer-review started: April 30, 2015
First decision: August 16, 2015
Revised: September 1, 2015
Accepted: September 16, 2015
Article in press: September 18, 2015
Published online: October 25, 2015
Processing time: 174 Days and 21.1 Hours
Abstract

Endoscopic ultrasound (EUS) is used for diagnosis and evaluation of many diseases of the gastrointestinal (GI) tract. In the past, it was used to guide a cholangiography, but nowadays it emerges as a powerful therapeutic tool in biliary drainage. The aims of this review are: outline the rationale for endoscopic ultrasound-guided biliary drainage (EGBD); detail the procedural technique; evaluate the clinical outcomes and limitations of the method; and provide recommendations for the practicing clinician. In cases of failed endoscopic retrograde cholangiopancreatography (ERCP), patients are usually referred for either percutaneous transhepatic biliary drainage (PTBD) or surgical bypass. Both these procedures have high rates of undesirable complications. EGBD is an attractive alternative to PTBD or surgery when ERCP fails. EGBD can be performed at two locations: transhepatic or extrahepatic, and the stent can be inserted in an antegrade or retrograde fashion. The drainage route can be transluminal, duodenal or transpapillary, which, again, can be antegrade or retrograde [rendezvous (EUS-RV)]. Complications of all techniques combined include pneumoperitoneum, bleeding, bile leak/peritonitis and cholangitis. We recommend EGBD when bile duct access is not possible because of failed cannulation, altered upper GI tract anatomy, gastric outlet obstruction, a distorted ampulla or a periampullary diverticulum, as a minimally invasive alternative to surgery or radiology.

Keywords: Endoscopic ultrasound; Rendezvous; Biliary drainage; Obstrutive cancer; Papillary obstrution

Core tip: In this minireview, we will discuss about endoscopic ultrasound-guided biliary drainage (EGBD) and new interesting endoscopic ultrasound therapeutic biliary methods. We recommend EGBD when bile duct access is not possible because of failed cannulation, altered upper gastrointestinal tract anatomy, gastric outlet obstruction, a distorted ampulla or periampullary diverticulum, as a minimally invasive alternative to surgery or radiology.