Endoscopic ultrasonography-guided biliary drainage: Who, when, which, and how?

World J Gastroenterol. 2016 Jan 21;22(3):1297-303. doi: 10.3748/wjg.v22.i3.1297.


Both endoscopic ultrasonography (EUS)-guided choledochoduodenostomy (EUS-CDS) and EUS-guided hepaticogastrostomy (EUS-HGS) are relatively well established as alternatives to percutaneous transhepatic biliary drainage (PTBD). Both EUS-CDS and EUS-HGS have high technical and clinical success rates (more than 90%) in high-volume centers. Complications for both procedures remain high at 10%-30%. Procedures performed by endoscopists who have done fewer than 20 cases sometimes result in severe or fatal complications. When learning EUS-guided biliary drainage (EUS-BD), we recommend a mentor's supervision during at least the first 20 cases. For inoperable malignant lower biliary obstruction, a skillful endoscopist should perform EUS-BD before EUS-guided rendezvous technique (EUS-RV) and PTBD. We should be select EUS-BD for patients having altered anatomy from malignant tumors before balloon-enteroscope-assisted endoscopic retrograde cholangiopancreatography, EUS-RV, and PTBD. If both EUS-CDS and EUS-HGS are available, we should select EUS-CDS, according to published data. EUS-BD will potentially become a first-line biliary drainage procedure in the near future.

Keywords: Endoscopic ultrasonography; Endoscopic ultrasonography-guided biliary drainage; Endoscopic ultrasonography-guided choledochoduodenostomy; Endoscopic ultrasonography-guided rendezvous technique; Interventional endoscopic ultrasonography.

Publication types

  • Review

MeSH terms

  • Cholestasis / diagnostic imaging
  • Cholestasis / therapy*
  • Clinical Competence
  • Drainage / adverse effects
  • Drainage / instrumentation
  • Drainage / methods*
  • Endosonography / adverse effects
  • Endosonography / instrumentation
  • Humans
  • Learning Curve
  • Patient Selection
  • Risk Factors
  • Stents
  • Treatment Outcome
  • Ultrasonography, Interventional* / adverse effects
  • Ultrasonography, Interventional* / instrumentation