ASGE Therapeutic EUS for Advanced Endosonographers (Live and Virtual) | September 2022-3 Tyberg

3 Tyberg_EUS Guided Biliary and Pancreatic Access

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This document provides an overview of EUS-Guided Biliary and Pancreatic Access as a therapeutic endoscopic ultrasound (EUS) procedure. EUS-BD is an alternative therapy for biliary obstruction that cannot be managed by conventional ERCP. The success rates for EUS-BD are high, with technical success at 94.71% and clinical success at 91.66%. The adverse event rate is 23.3%.<br /><br />There are different procedural approaches for biliary access, including intrahepatic and extrahepatic stent placement. Recent studies suggest that choledochoduodenostomy may have longer stent patency but possibly higher adverse events. The choice of stent depends on factors such as type of drainage, duct diameter, lumen to duct distance, and the nature of the obstruction.<br /><br />Compared to conventional ERCP, EUS-BD has shown comparable efficacy and improved safety. It has been found to be a primary treatment option for malignant biliary obstruction.<br /><br />EUS-PD is an alternative option for relieving pancreatic duct obstruction in chronic pancreatitis. The success rates for EUS-PD vary between 25-100% for technical success and 50-70% for clinical success. The choice of stent for pancreatic duct drainage is more limited compared to biliary drainage.<br /><br />The document also highlights the importance of choosing the appropriate technique based on accessibility and anatomy. EUS-BD and EUS-PD can serve as a bridge to surgical resection in cases of malignant biliary obstruction or provide relief when conventional ERCP fails.<br /><br />Overall, EUS-Guided Biliary and Pancreatic Access procedures are effective alternatives to conventional ERCP, offering high success rates and improved safety. The choice of technique and stent depends on individual patient factors.

Keywords

EUS-Guided Biliary and Pancreatic Access

therapeutic endoscopic ultrasound

EUS-BD

biliary obstruction

ERCP

stent placement

choledochoduodenostomy

stent patency

malignant biliary obstruction

EUS-PD