title: Endoscopic ultrasonography-guided biliary drainage: Who, when, which, and how?
abstract: 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.
authors.affiliation: Kazuo Hara, Kenji Yamao, Nobumasa Mizuno, Susumu Hijioka, Hiroshi Imaoka, Nozomi Okuno, Nobuhiro Hieda, Tukasa Yoshida, Department of Gastroenterology, Aichi Cancer Center Hospital, Nagoya 464-8681, Japan.
authors.forename: Kazuo
authors.initials: K
authors.lastname: Hara
authors.affiliation: Kazuo Hara, Kenji Yamao, Nobumasa Mizuno, Susumu Hijioka, Hiroshi Imaoka, Nozomi Okuno, Nobuhiro Hieda, Tukasa Yoshida, Department of Gastroenterology, Aichi Cancer Center Hospital, Nagoya 464-8681, Japan.
authors.forename: Kenji
authors.initials: K
authors.lastname: Yamao
authors.affiliation: Kazuo Hara, Kenji Yamao, Nobumasa Mizuno, Susumu Hijioka, Hiroshi Imaoka, Nozomi Okuno, Nobuhiro Hieda, Tukasa Yoshida, Department of Gastroenterology, Aichi Cancer Center Hospital, Nagoya 464-8681, Japan.
authors.forename: Nobumasa
authors.initials: N
authors.lastname: Mizuno
authors.affiliation: Kazuo Hara, Kenji Yamao, Nobumasa Mizuno, Susumu Hijioka, Hiroshi Imaoka, Nozomi Okuno, Nobuhiro Hieda, Tukasa Yoshida, Department of Gastroenterology, Aichi Cancer Center Hospital, Nagoya 464-8681, Japan.
authors.forename: Susumu
authors.initials: S
authors.lastname: Hijioka
authors.affiliation: Kazuo Hara, Kenji Yamao, Nobumasa Mizuno, Susumu Hijioka, Hiroshi Imaoka, Nozomi Okuno, Nobuhiro Hieda, Tukasa Yoshida, Department of Gastroenterology, Aichi Cancer Center Hospital, Nagoya 464-8681, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Imaoka
authors.affiliation: Kazuo Hara, Kenji Yamao, Nobumasa Mizuno, Susumu Hijioka, Hiroshi Imaoka, Nozomi Okuno, Nobuhiro Hieda, Tukasa Yoshida, Department of Gastroenterology, Aichi Cancer Center Hospital, Nagoya 464-8681, Japan.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Tajika
authors.affiliation: Kazuo Hara, Kenji Yamao, Nobumasa Mizuno, Susumu Hijioka, Hiroshi Imaoka, Nozomi Okuno, Nobuhiro Hieda, Tukasa Yoshida, Department of Gastroenterology, Aichi Cancer Center Hospital, Nagoya 464-8681, Japan.
authors.forename: Tutomu
authors.initials: T
authors.lastname: Tanaka
authors.affiliation: Kazuo Hara, Kenji Yamao, Nobumasa Mizuno, Susumu Hijioka, Hiroshi Imaoka, Nozomi Okuno, Nobuhiro Hieda, Tukasa Yoshida, Department of Gastroenterology, Aichi Cancer Center Hospital, Nagoya 464-8681, Japan.
authors.forename: Makoto
authors.initials: M
authors.lastname: Ishihara
authors.affiliation: Kazuo Hara, Kenji Yamao, Nobumasa Mizuno, Susumu Hijioka, Hiroshi Imaoka, Nozomi Okuno, Nobuhiro Hieda, Tukasa Yoshida, Department of Gastroenterology, Aichi Cancer Center Hospital, Nagoya 464-8681, Japan.
authors.forename: Nozomi
authors.initials: N
authors.lastname: Okuno
authors.affiliation: Kazuo Hara, Kenji Yamao, Nobumasa Mizuno, Susumu Hijioka, Hiroshi Imaoka, Nozomi Okuno, Nobuhiro Hieda, Tukasa Yoshida, Department of Gastroenterology, Aichi Cancer Center Hospital, Nagoya 464-8681, Japan.
authors.forename: Nobuhiro
authors.initials: N
authors.lastname: Hieda
authors.affiliation: Kazuo Hara, Kenji Yamao, Nobumasa Mizuno, Susumu Hijioka, Hiroshi Imaoka, Nozomi Okuno, Nobuhiro Hieda, Tukasa Yoshida, Department of Gastroenterology, Aichi Cancer Center Hospital, Nagoya 464-8681, Japan.
authors.forename: Tukasa
authors.initials: T
authors.lastname: Yoshida
authors.affiliation: Kazuo Hara, Kenji Yamao, Nobumasa Mizuno, Susumu Hijioka, Hiroshi Imaoka, Nozomi Okuno, Nobuhiro Hieda, Tukasa Yoshida, Department of Gastroenterology, Aichi Cancer Center Hospital, Nagoya 464-8681, Japan.
authors.forename: Yasumasa
authors.initials: Y
authors.lastname: Niwa
mesh_terms: D002779:Cholestasis / Q000000981:diagnostic imaging / Q000628:therapy*; D002983:Clinical Competence; D004322:Drainage / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D019160:Endosonography / Q000009:adverse effects / Q000295:instrumentation; D006801:Humans; D059032:Learning Curve; D018579:Patient Selection; D012307:Risk Factors; D015607:Stents; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional / Q000009:adverse effects / Q000295:instrumentation
keywords: Endoscopic ultrasonography; Endoscopic ultrasonography-guided biliary drainage; Endoscopic ultrasonography-guided choledochoduodenostomy; Endoscopic ultrasonography-guided rendezvous technique; Interventional endoscopic ultrasonography
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