title: Endoscopic ultrasound-assisted bile duct access and drainage: multicenter, long-term analysis of approach, outcomes, and complications of a technique in evolution.
abstract: OBJECTIVE
  When endoscopic retrograde cholangio-pancreatography fails, the bile duct is drained percutaneously or surgically. Evolution of endoscopic ultrasound (EUS) has provided the ability to visualize and also drain the biliary tree. The aim of this study was to review different techniques of EUS-guided bile duct access and drainage, and compare extrahepatic (EH) and intrahepatic (IH) approaches and benign with malignant indications.
  
  
  METHODS
  EUS-guided attempts at bile duct drainage from 6 international centers were reviewed. This is a multicenter, nonrandomized retrospective study.
  
  
  RESULTS
  Two hundred forty patients underwent EUS-guided bile duct access and drainage (EUS-BD) with a mean age of 67.3 years. The IH approach was used in 60% of the cases. In 99% of the subjects, a 19-G needle was used. Success was achieved in 87% cases, with a similar success rate in EH and IH approaches (84.3% vs. 90.4%; P=0.15). Metal stents were placed in 60% and plastic stents in 27% of the cases. A higher success rate was noted in malignant diseases compared with benign diseases (90.2% vs. 77.3%; P=0.02). Complications for all techniques included pneumoperitoneum 5%, bleeding 11%, bile leak/peritonitis 10%, and cholangitis 5%. No significant difference was noted between the IH and the EH approaches (32.6% vs. 35.6%; P=0.64), with similar rates in benign and malignant diseases (26.7% vs. 37.1%; P=0.19).
  
  
  CONCLUSIONS
  The EUS-BD technique is currently limited by a lack of dedicated devices and large data reporting outcomes and complications. Larger prospective and multicenter studies are needed to better define the indications, outcomes, and complications. With greater experience and dedicated devices, EUS-BD can be an effective alternative.
authors: *Cedars-Sinai Medical Center, Los Angeles, CA †Hospital del Rio Hortega, Valladolid, Spain ‡Department of Gastroenterology, University of Virginia, Charlottesville, VA §Department of Gastroenterology, University of Sao Paulo, Sao Paulo, Brazil ∥Tokyo Medical University Hospital, Tokyo, Japan ¶Department of Gastroenterology, University of Minnesota, Minneapolis, MN #Paoli-Calmettes Institute, Marseille, France.
authors: Kapil
authors: K
authors: Gupta
authors: Manuel
authors: M
authors: Perez-Miranda
authors: Michel
authors: M
authors: Kahaleh
authors: Everson L A
authors: EL
authors: Artifon
authors: Takao
authors: T
authors: Itoi
authors: Martin L
authors: ML
authors: Freeman
authors: Carlos
authors: C
authors: de-Serna
authors: Bryan
authors: B
authors: Sauer
authors: Marc
authors: M
authors: Giovannini
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002779:Cholestasis / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy*; D004322:Drainage / Q000009:adverse effects / Q000379:methods*; D019160:Endosonography / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015607:Stents; D013997:Time Factors