title: Endoscopic ultrasonography-guided biliary and pancreatic duct interventions.
abstract: Drainage of obstructed bile duct and pancreatic duct under endoscopic ultrasonography (EUS) guidance has evolved into viable techniques suitable for patients with failed endoscopic retrograde cholangiopancreatography (ERCP) and/or altered surgical anatomy. One of the major advantages of EUS guidance is the possibility of multiple access points depending upon patient and ductal anatomy. Unlike ERCP, an approachable papilla is not a requisite for successful EUS-guided biliary or pancreatic ductal drainage. Moreover, as the access is away from the papilla, there is the possibility of reduced pancreatitis. A variety of procedures have become available for EUS-guided drainage, and it is important to develop standard terminology and procedural details. EUS-specific stents, including lumen-apposing metal stents have recently become available, and are likely to impact the outcomes of these procedures. Available data show a high success rate and acceptable adverse event rate for EUS-guided biliary drainage. Success rate appears to be low for pancreatic duct drainage because of a variety of reasons. Outcomes of EUS-guided biliary drainage appear equivalent to percutaneous drainage and ERCP. EUS-guided gallbladder drainage appears promising for patients requiring gallbladder drainage but unfit for surgery. Further large controlled studies are needed to evaluate the exact role of these procedures.
authors.affiliation: Baldota Institute of Digestive Sciences, Global Hospitals, Mumbai, India.
authors.forename: Vinay
authors.initials: V
authors.lastname: Dhir
authors.affiliation: Graduate School of Medicine, University of Tokyo, Tokyo, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Isayama
authors.affiliation: Tokyo Medical University, Tokyo, Japan.
authors.forename: Takao
authors.initials: T
authors.lastname: Itoi
authors.affiliation: King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia.
authors.forename: Majid
authors.initials: M
authors.lastname: Almadi
authors.affiliation: Bangkok Hospital, Bangkok, Thailand.
authors.forename: Aroon
authors.initials: A
authors.lastname: Siripun
authors.affiliation: Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong.
authors.forename: Anthony Y B
authors.initials: AYB
authors.lastname: Teoh
authors.affiliation: National University Health System, Singapore.
authors.forename: Khek Yu
authors.initials: KY
authors.lastname: Ho
mesh_terms: D002779:Cholestasis / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D004322:Drainage / Q000379:methods*; D019160:Endosonography / Q000379:methods*; D006801:Humans; D010183:Pancreatic Ducts / Q000000981:diagnostic imaging* / Q000601:surgery*; D018579:Patient Selection; D015607:Stents; D018084:Ultrasonography, Interventional / Q000379:methods*
keywords: ERCP; biliary drainage; chronic pancreatitis; endoscopic ultrasound