Endoscopic ultrasound-guided drainage of the biliary system: Techniques, indications and future perspectives

Table 1 Outcome of endoscopic ultrasound-guided biliary drainage

First Author, Yr	Type of study	Type of malignant obstruction	Number patients	Technical Success rate	ClinicalSuccess rate	Adverse events
Kanno et al[40], 2018	(1) Retrospective, single center; and (2) Failed ERCP/inaccessible papilla	Unresectable	99	98%	93%	Overall: 10%
Rai et al[38], 2018	(1) Retrospective, single center; and (2) Failed ERCP or duodenal obstruction	(1) Unresectable; and (2) Distal	30	93.3%	93.3%	(1) Overall: 10%; and (2) 83% stent patency (3 mo)
Alvarez-Sánchez et al[37], 2018	(1) Retrospective, single center; and (2) Failed ERCP	(1) With/out ascites; and (2) Distal or proximal	31; Ascites: 11	100%	(1) No ascites: 95%; and (2) Ascites: 64%	(1) No ascites: 20%; and (2) Ascites: 9%
Iwashita et al[36], 2017	(1) Prospective, single center; and (2) Altered anatomy	Unresectable	20	95%	95%	20%
Minaga et al[52], 2017	(1) Retrospective, single center; and (2) Failed ERCP	(1) Unresectable; and (2) Hilar obstruction	30	96.7%	75.9%	(1) Early: 10%; and (2) Late: 23.3%
Makmun et al[41], 2017	(1) Retrospective, single center; and (2) Failed ERCP	Distal and proximal	24	100%	79.1%	16.7%
Ogura et al[53], 2017	(1) Retrospective, single center; Failed ERCP	Hilar obstruction	10	100%	90%	0%
Lu et al[42], 2017	(1) Retrospective, single center; and (2) Failed ERCP	Distal and proximal	24	95.8%	100%	13%
Cho et al[51], 2017	(1) Prospective; and (2) Failed ERCP		54	100%	94.4%	16.6%
Amano et al[48], 2017	Prospective		20	100%		15%
Kunda et al[43], 2016	(1) Retrospective, single center; and (2) Failed ERCP	(1) Unresectable; and (2) Distal	57	98.2%	94.7%	7%
Nakai et al[61], 2016	(1) Retrospective, multicenter; and (2) Primary EUS	(1) Unresectable Distal and proximal	33	100%	100%	9%
Guo et al[44], 2016	(1) Retrospective, single center; and (2) Failed ERCP		21	100%	100%	19%
Khashab et al[45], 2016	(1) Prospective, multicenter; and (2) Failed ERCP	Distal	96	95.8%	89.5%	(1) 10.5%; and (2) 86% stent patency (1 yr)
Ogura et al[49], 2016	Retrospective, single center		39			(1) CDS: 6%; and (2) HGS: 2%
Dhir et al[34], 2015	(1) Retrospective, multicenter; and (2) Failed ERCP		104	95.%	90.9%	6.8%
Park et al[47], 2015	(1) Prospective, randomized; and (2) After failed ERCP	Distal and proximal	22	(1) CDS: 92%; and (2) HGS: 100%	(1) CDS: 92%; and (2) HGS: 100%	(1) Early CDS: 25% vs HGS: 0%; and (2) Late CDS: 8.3% vs HGS: 25%
Artifon et al[50], 2015	(1) Prospective, randomized, single center; Failed ERCP	Distal	49	(1) CDS: 91%; HGS: 96%	(1) CDS: 77%; HGS: 91%	(1) CDS: 12.5%; and (2) HGS: 20%
Dhir et al[33], 2014	(1) Retrospective, multicenter; and (2) Failed ERCP	Distal and proximal	68	95.6%		20.6%
Kawakubo et al[32], 2014	(1) Retrospective, multicenter; and (2) Failed ERCP	Unresectable Proximal and distal	64	95%		19%
Song et al[21], 2014	(1) Prospective, single center; and (2) Failed ERCP	Proximal and distal	27	100%	96.3%	18.5%
Prachayakul et al[35], 2013	(1) Retrospective, single center; and (2) Failed ERCP	Proximal and distal	22	95.2%	90.5%	9.5%
Hara et al[62], 2013	(1) Prospective , single center; and (2) First line	Distal	18	95%	95%	11%
Khashab et al[45], 2013	(1) Retrospective, multicenter; and (2) Failed ERCP	Distal	35	97%	94%	12%
Kim et al[27], 2012	(1) Retrospective, single center; and (2) Failed ERCP	Proximal and distal	13	92.3%	91.7%
Iwashita et al[30], 2012	(1) Retrospective, single center; and (2) Failed ERCP		40	73%		13%
Song et al[21], 2012	(1) Prospective, single center; and (2) Failed ERCP	Distal	15	86.7%	100%	23.1%
Hara et al[19], 2011	(1) Prospective, single center; and (2) Failed ERCP	Distal	18	94%	100%	17%
Ramírez-Luna et al[18], 2011	(1) Prospective, single center; and (2) Failed ERCP or PTC		11	91%	90%	n = 2
Fabbri et al[16], 2011	(1) Prospective, single center; and (2) Failed ERCP	Proximal and distal	16	100%	75%	6.3%
Park et al[11], 2009	(1) Prospective, single center; and (2) Failed ERCP	Distal	14	100%	100%

EH: Extrahepatic; IH: Intrahepatic; AG: Antegrade; CDS: Choledochoduodenostomy; HGS: Hepaticogastrostomy; RV: Rendezvous; GG: Gastro-gallbladder; HES: Hepaticoesophageostomy; SEMS: Self-expandable metal.

Table 2 Studies comparing endoscopic ultrasound-guided biliary drainage and percutaneous transhepatic cholangiography

Author, Yr	Type of study	Type malignant obstruction	Number patients	Technical Succes rate	Clinical Succes rate	Complications, EUS vs PTC
Téllez-Ávila et al[60], 2018	(1) Retrospective; and (2) Failed ERCP	(1) Malignant 56.4%; and (2) Distal	(1) Total: 62; (2) EUS: 30; and (3) PTC: 32	(1) EUS: 90%; and (2) PTC: 78.1%	(1) EUS: 96%; and (2) PTC: 63%	Overall: 6% vs 28.1%
Sportes et al[57], 2017	(1) Retrospective, multicenter; and (2) Failed ERCP or altered anatomy	(1) Unresectable; and (2) Distal	(1) Total: 51; (2) EUS: 31; and (3) PTC: 20	(1) EUS: 100%; and (2) PTC: 100%	(1) EUS: 86%; and (2) PTC: 83%	(1) Overall: 16% vs 10%; and (2) Reintervention: 6.5% vs 105%
Lee et al[58], 2016	(1) Randomized, multicenter; and (2) Inaccessible papilla	(1) Unresectable; and (2) Distal	(1) Total: 66; (2) EUS: 34; and (3) PTC: 32	(1) EUS: 94.1%; and (2) PTC: 96.9%	(1) EUS: 87.5%; and (2) PTC: 87.1%	(1) Overall: 8.8% vs 31.2%; and (2) Reintervention: 25% vs 54.8%
Torres-Ruiz, 2016; Abstract	Failed ERCP	Distal and proximal	(1) Total: 66; (2) EUS: 35; and (3) PTC: 31	(1) EUS: 81%; and (2) PTC: 90.3%	(1) EUS: 90%; and (2) PTC: 68.7%	(1) Early: 10.8% vs 9%; (2) Late: 16.6% vs 54%; and (3) Reintervention: 8.5% vs 45.1%
Sharaiha et al[56], 2016	(1) Retrospective, single center; and (2) Failed ERCP	Malignant: 83.3%	(1) Total: 60; (2) EUS: 47; and (3) PTC: 13	(1) EUS: 93.3%; and (2) PTC: 91.6%	(1) EUS: 62.2%; and (2) PTC: 25%	(1) Late: 6.6% vs 53.8%; and (2) Reintervention: 6.6% vs 53.8%
Bill et al[59], 2015	(1) Retrospective, single center; and (2) Failed ERCP	Distal	(1) Total: 50; (2) EUS: 25; and (3) PTC: 25	(1) EUS: 76%; and (2) PTC: 100%	(1) EUS: 96%; and (2) PTC: 80%	(1) Early: 16% vs 12%; (2) Late: 12% vs 5%; and (3) Reintervention: 15.8% vs 60%
Giovannini, 2015; Abstract	(1) Randomized, multicenter; and (2) Failed ERCP or impossible	Malignant: 90.2%	(1) Total: 41; (2) EUS: 20; and (3) PTC: 21	(1) EUS: 95%; and (2) PTC: 100%	(1) EUS: 95%; and (2) PTC: 85%	Overall: 35% vs 60%
Khashab et al[45], 2015	(1) Retrospective, multicenter; and (2) Failed ERCP	Distal	(1) Total: 73; (2) EUS: 22; and (3) PTC: 51	(1) EUS: 86.4%; and (2) PTC: 100%	(1) EUS: 86.4%; and (2) PTC: 92.2%	(1) Overall: 18.2% vs 39.2%; and (2) Reintervention: 15.7% vs 80.4%
Bapaye et al[55], 2013	(1) Retrospective, single center; and (2) Inaccessible papil	Unresectable	(1) Total: 51; (2) EUS: 25; and (3) PTC: 26	(1) EUS: 92%; and (2) PTC: 46%	(1) EUS: 92%; and (2) PTC: 46%	Overall: 20% vs 46%
Artifon et al[54], 2012	(1) Prospective, randomized; and (2) Failed ERCP	Unresectable	(1) Total: 25; (2) EUS: 13; and (3) PTC: 12	(1) CDS: 100%; and (2) PTC: 100%	(1) CDS: 100%; and (2) PTC: 100%	Overall: 15.3% vs 25%

EH: Extrahepatic; IH: Intrahepatic; AG: Antegrade; CDS: Choledochoduodenostomy; HGS: Hepaticogastrostomy; RV: Rendezvous; GG: Gastro-gallbladder; HES: Hepaticoesophageostomy; SEMS: Self-expandable metal stent.

Table 3 Studies comparing primary endoscopic ultrasound-guided biliary drainage and endoscopic retrograde cholangiopancreaticography

First Author, Yr	Type of study	Type malignant obstruction	Number patients	Technical Success rate	ClinicalSucess rate	Adverse events; EUS vs ERCP
Paik et al[5], 2018	Prospective randomized multicenter	Unresectable; Distal	Total: 125; CDS: 32; HGS: 32; ERCP: 61	EUS: 93.8%; CDS: 90.6%; HGS: 96.9%; ERCP: 90.2%	EUS: 90.0%; ERCP: 94.5%	Overall: 6.3% vs 19.7%; Pancreatitis: 0% vs 14.8%; Reintervention: 15.6% vs 42.6%; Stent patency: 85.1% vs 48.9%
Bang et al[6], 2018	Prospective randomized single center	Pancreatic cancer; Distal	Total: 67; CDS: 33; ERCP: 34	CDS: 90.9%; ERCP: 94.1%	CDS: 97%; ERCP: 91.2%	Overall: 21.2% vs 14.7%; Reintervention: 3.0% vs 2.9%
Park et al[7], 2018	Prospective randomized single center	Unresectable; Extrahepatic; Distal	Total: 30; CDS: 15; ERCP: 15	CDS: 92.8%; ERCP: 100%	CDS: 100%; ERCP: 92.8%	Overall: 0% vs 0%; Stent dysfunction: 15.4% vs 30.8%
Kawakubo et al[63], 2016	Retrospective single center	Distal	Total: 82; CDS: 26; ERCP: 56	CDS: 96.2%; ERCP: 98.2%		Overall: 26.9% vs 35.7%; Pancreatitis: 0% vs 16.1%; Reintervention (1 yr): 16.6% vs 13.6%

CDS: Choledochoduodenostomy; HGS: Hepaticogastrostomy; SEMS: Self-expandable metal stent.