EUS-guided biliary drainage by using a standardized approach for malignant biliary obstruction: rendezvous versus direct transluminal techniques (with videos)

Gastrointest Endosc. 2013 Nov;78(5):734-41. doi: 10.1016/j.gie.2013.05.013. Epub 2013 Jul 22.


Background: EUS-guided biliary drainage (EGBD) can be performed via direct transluminal or rendezvous techniques. It is unknown how both techniques compare in terms of efficacy and adverse events.

Objective: To describe outcomes of EGBD performed by using a standardized approach and compare outcomes of rendezvous and transluminal techniques.

Design: Retrospective analysis of prospectively collected data.

Setting: Two tertiary-care centers.

Patients: Consecutive jaundiced patients with distal malignant biliary obstruction who underwent EGBD after failed ERCP between July 2006 and December 2012 were included.

Intervention: EGBD by using a standardized algorithm.

Main outcome measurements: Technical success, clinical success, and adverse events.

Results: During the study period, 35 patients underwent EGBD (rendezvous n = 13, transluminal n = 20). Technical success was achieved in 33 patients (94%), and clinical success was attained in 32 of 33 patients (97.0%). The mean postprocedure bilirubin level was 1.38 mg/dL in the rendezvous group and 1.33 mg/dL in the transluminal group (P = .88). Similarly, length of hospital stay was not different between groups (P = .23). There was no significant difference in adverse event rate between rendezvous and transluminal groups (15.4% vs 10%; P = .64). Long-term outcomes were comparable between groups, with 1 stent migration in the rendezvous group at 62 days and 1 stent occlusion in the transluminal group at 42 days after EGBD.

Limitations: Retrospective analysis, small number of patients, and selection bias.

Conclusion: EGBD is safe and effective when the described standardized approach is used. Stent occlusion is not common during long-term follow-up. Both rendezvous and direct transluminal techniques seem to be equally effective and safe. The latter approach is a reasonable alternative to rendezvous EGBD.

Keywords: EGBD; ERC; EUS-guided biliary drainage; SEMS; endoscopic retrograde cholangiography; self-expandable metal stent.

Publication types

  • Video-Audio Media

MeSH terms

  • Adenocarcinoma / complications
  • Aged
  • Ampulla of Vater / surgery*
  • Carcinoma / complications
  • Carcinoma / secondary
  • Cholangiocarcinoma / complications
  • Cholestasis / etiology
  • Cholestasis / surgery*
  • Common Bile Duct Neoplasms / complications
  • Drainage / methods*
  • Duodenal Neoplasms / complications
  • Endosonography / methods*
  • Female
  • Gastric Outlet Obstruction / complications
  • Humans
  • Jaundice, Obstructive / etiology
  • Jaundice, Obstructive / surgery*
  • Male
  • Middle Aged
  • Pancreatic Neoplasms / complications
  • Pancreatic Neoplasms / secondary
  • Retrospective Studies
  • Stents
  • Stomach Neoplasms / complications
  • Treatment Outcome
  • Ultrasonography, Interventional / methods*