Interventional Endoscopic Ultrasound (EUS) (on demand)-Kantsevoy_EUS_biliary_ductal

Pdf Summary

The presentation reviews endoscopic ultrasound (EUS)-assisted biliary drainage, including rendezvous access, choledochoduodenostomy (EUS-CDS), and hepaticogastrostomy (EUS-HGS).<br /><br />EUS-guided rendezvous is primarily used after failed ERCP. Reported technical success is 94–96% and clinical success 87–88%. Adverse events occur in 13–34%, with higher risk after intrahepatic puncture; complications include pneumoperitoneum, cholangitis, peritonitis, bleeding, and pancreatitis. Contraindications include an intervening blood vessel, coagulopathy, ascites, and nondilated ducts. In a small series after Roux-en-Y gastric bypass, EUS rendezvous succeeded in all five patients whose balloon-assisted ERCP had failed, with no adverse events.<br /><br />For EUS-CDS and EUS-HGS, procedural choices include needle and guidewire size, tract-dilation method, and plastic or metal stents, including lumen-apposing metal stents. A meta-analysis reported technical success of 94% for EUS-CDS and 96% for EUS-HGS, and clinical success of 88% and 87%, respectively. Early adverse events include abdominal pain, cholangitis, bile leak, and perforation; later stent occlusion may require repeat intervention.<br /><br />Compared with ERCP for primary palliation of malignant biliary obstruction, EUS-guided drainage has similarly high technical and clinical success. Trials reported fewer procedure-related and late adverse events and better six-month stent patency with EUS-guided drainage. Compared with percutaneous transhepatic biliary drainage, EUS-guided drainage has comparable technical success, similar or higher clinical success, and fewer adverse events.

Meta Tag

Concept Endoscopic Ultrasound-Guided Biliary Drainage

Concept Biliary rendezvous

Concept Choledochoduodenostomy

Concept Hepaticogastrostomy

Concept Endoscopic Retrograde Cholangiopancreatography

Keywords

endoscopic ultrasound

EUS-guided biliary drainage

rendezvous access

choledochoduodenostomy

hepaticogastrostomy

ERCP failure

malignant biliary obstruction

technical success

stent patency

adverse events

lumen-apposing metal stents

clinical success