Comprehensive review on EUS-guided biliary drainage

Table 1 Current indications for endoscopic ultrasonography-guided biliary drainage after failure of endoscopic retrograde cholangiopancreatography in referral centers

Accessible papilla

Ampullary pathology

Periampullary diverticulum

Ampullary neoplastic infiltration

Non-accessible papilla

Peptic GI stenosis

Malignant GI strictures

Gastrointestinal bariatric bypass

Roux-en Y gastric by-pass

Billroth II gastroenterostomy

GI: Gastrointestinal.

Table 2 Algorithms for guidance endoscopic ultrasonography-guided biliary drainage

Ref.	Design	Proposed algorithm	No. of patients	Technical success rate	Complication rate
Park et al[35]	PS	“Enhanced guidewire manipulation protocol” EUS-RV/EUS-AS with guidewire manipulation protocol as a first-line In case of failure or duodenal invasion, transmural EUS-BD	45	91%	11%
Tyberg et al[20]	PS	“Patient anatomy” Dilated IHBT on cross-sectional imaging, received IHa Nondilated IHBT on cross-sectional imaging, received EHa In case of failure of IHa, conversion to an EHa	52	96%	10%

PS: Prospective study; EUS-RV: Endoscopic ultrasonography-guided rendez; EUS-AS: Endoscopic ultrasonography-guided antegrade stent placement; EUS-BD: Endoscopic ultrasonography-guided biliary drainage; IHBT: Intrahepatic biliary tree; IHa: Intrahepatic approach; EHa: Extrahepatic approach.

Table 3 Comparative studies among different techniques of biliary drainage

Ref.	Design	Technique	No. of patients	Technical success rate	Complication rate
Artifon et al[33]	PS	EUS-HGA vs EUS-CDS	49	96% vs 91%	20% vs 12.5%
Khashab et al[34]	PS	EUS-HGA vs EUS-CDS	121	91.8 vs 93.3%	19.6% vs 13.3%
Sharaiha et al[16]	RS rev	PTBD vs EUS-BD	60	84.6% vs 91.4%	25% vs 13%
Artifon et al[7]	PS	PTBD vs EUS-CDS	25	100% vs 100%	25% vs 15.3%
Bapaye et al[8]	RS	PTBD vs EUS-BD	50	100% vs 92%	46% vs 20%
Bill et al[10]	RS	PTBD vs EUS-RV	50	100% vs 76%	17% vs 28%
Jang et al[28]	PS	PTGD vs EUS-GBD	29	97% vs 97%	3% vs 7%
Khashab et al[9]	PS	PTBD vs EUS-BD	73	100% vs 86.4%	39.2% vs 18.2%

PS: Prospective study; RS: Retrospective study; Rev: Review; EUS-BD: Endoscopic ultrasonography-guided biliary drainage; EUS-HGA: Endoscopic ultrasonography-guided hepatogastric anastomosis; EUS-CDS: Endoscopic ultrasonography-guided choledochoduodenostomy; EUS-RV: Endoscopic ultrasonography-guided rendezvous; EUS-GBD: Echoendoscopic transgallbladder drainage.

Table 4 Advantages and disadvantages of the different techniques

	Advantages	Disadvantages
ERCP	Widely available Relative low complication rate (compared to PTBD and EUS-BD)	Not feasible in case of inaccessible papilla
PTBD	Available rescue therapy for ERCP failure	High complication rate (bleeding-infection) External catheter Contraindicated if ascites
EUS	Different possible approaches (HGA, CDS, GBD, RV) Internal drainage Same session of failed ERCP Fewer re-interventions	Not widely available High endoscopic ERCP/EUS expertise required Not yet standardized algorithm

ERCP: Endoscopic retrograde cholangiopancreatography; PTBD: Percutaneous transhepatic biliary drainage; EUS: Endoscopic ultrasonography; EUS-BD: Endoscopic ultrasonography-guided biliary drainage; HGA: Hepatogastric anastomosis; CDS: Choledochoduodenostomy; RV: Rendezvous; GBD: Transgallbladder drainage.