Interventional Endoscopic Ultrasound (EUS) | October 2026-02 Biliary Ductal Drainage

Video Transcription

Video Summary

The session reviewed EUS-guided biliary drainage as a salvage option after failed ERCP. For rendezvous procedures, access is gained through the common bile duct from the duodenal bulb or through the left liver lobe from the stomach; a guidewire is advanced across the papilla for subsequent ERCP. Coagulopathy is a contraindication, ascites a relative one, and nondilated ducts make access difficult. Panelists discussed needle and wire selection, generally favoring a 19-gauge needle, with 0.025-inch wire often useful for extensive manipulation. Stable scope positioning and a good access window were emphasized.<br /><br />For procedures completed under EUS guidance, options include choledochoduodenostomy (CDS) and hepaticogastrostomy (HGS). Dilation methods vary, including balloons, cystotomes, and screw-type dilators. Stent choice depends on anatomy and goals; lumen-apposing metal stents are commonly used for CDS, while HGS requires careful attention to leak risk and stent positioning. Follow-up, pigtail placement, and patient prognosis should guide ongoing management.

Meta Tag

Concept Endoscopic Ultrasound-Guided Biliary Access

Concept Biliary rendezvous

Concept Endoscopic Ultrasound-Guided Biliary Drainage

Concept Guidewire

Concept Failed ERCP

Keywords

EUS-guided biliary drainage

failed ERCP

rendezvous procedure

choledochoduodenostomy

hepaticogastrostomy

lumen-apposing metal stent

Endoscopic Ultrasound-Guided Biliary Access

Biliary rendezvous

Endoscopic Ultrasound-Guided Biliary Drainage

Guidewire

Failed ERCP