ASGE Therapeutic EUS for Advanced Endosonographers (On-Demand) | September 2022-3 Tyberg

3 Tyberg_EUS Guided Biliary and Pancreatic Access

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This document discusses the use of endoscopic ultrasound (EUS)-guided biliary and pancreatic access for the management of biliary and pancreatic obstructions. EUS-BD is an alternative therapy when conventional endoscopic retrograde cholangiopancreatography (ERCP) fails, with a technical success rate of 94.71% and a clinical success rate of 91.66%. However, it is associated with an adverse event rate of 23.3%. The document compares different approaches for biliary access and stent placement, showing equal technical and clinical success rates for intrahepatic and extrahepatic approaches. The choice of stent depends on factors like drainage type, duct diameter, lumen to duct distance, and the nature of the obstruction. EUS-BD is considered non-inferior, and possibly superior, to conventional ERCP for biliary drainage prior to hepatobiliary surgery. It does not increase surgical complexity and should not impede patients from undergoing surgical intervention. <br /><br />EUS-PD is an alternative option for pancreatic duct drainage in patients with chronic pancreatitis when conventional ERCP fails. Initial data shows a technical success rate of 25-100% and a clinical success rate of 50-70%, but newer studies report more favorable results. The choice of stent for EUS-PD is limited to plastic stents and fully covered biliary self-expanding metal stents. Cautery may be required during the procedure. <br /><br />In conclusion, EUS-guided biliary and pancreatic access provide alternative options for the management of biliary and pancreatic obstructions when conventional ERCP fails. EUS-BD has comparable efficacy and improved safety compared to ERCP, and may become the preferential treatment for malignant biliary obstruction in surgically resectable patients. EUS-PD is an alternative option for pancreatic duct drainage in chronic pancreatitis. Overall, the choice of technique depends on the accessibility and anatomy of the patient.

Keywords

endoscopic ultrasound

EUS-guided

biliary access

pancreatic access

biliary obstructions

pancreatic obstructions

endoscopic retrograde cholangiopancreatography

ERCP

technical success rate

clinical success rate