Skip to main content
SpringerLink
Log in

Endoscopic Ultrasound-Guided Biliary Access and Drainage

  • Chapter
  • First Online:
Diagnostic and Therapeutic Procedures in Gastroenterology

Part of the book series: Clinical Gastroenterology ((CG))

  • 1775 Accesses

Abstract

Drainage of an obstructed biliary tree is an important part of the management of patients with obstructive jaundice. In addition to providing relief from the jaundice and infection, endoscopic biliary drainage improves the quality of life in such patients. These patients usually are managed with endoscopic retrograde cholangiopancreatography (ERCP), where the success rate of biliary cannulation is over 90%. Traditionally, these approaches have been percutaneous transhepatic biliary drainage (PTBD) or surgery. Surgery has a lower rate of recurrent biliary obstruction but is associated with prolonged hospitalization. These approaches have the disadvantage of being invasive and associated prolonged hospitalization. To circumvent these hurdles, in the last decade, endoscopic ultrasound (EUS) has been utilized to provide guidance to place stents endoscopically and provide biliary drainage internally into the gastrointestinal tract. EUS-guided biliary drainage (EUS-BD) has evolved as an additional method to provide the necessary relief of biliary obstruction in patients in whom ERCP has failed or is not possible. In this chapter, we discuss the various methods to gain access to the bile duct for efficient biliary decompression utilizing EUS.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 109.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 139.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 219.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Barkay O, Mosler P, Schmitt CM, Lehman GA, Frakes JT, Johanson JF, et al. Effect of endoscopic stenting of malignant bile duct obstruction on quality of life. J Clin Gastroenterol. 2013;47(6):526–31.

    Article  PubMed  Google Scholar 

  2. Adler DG, Lieb JG, Cohen J, Pike IM, Park WG, Rizk MK, et al. Quality indicators for ERCP. Am J Gastroenterol. 2015;81(1):54–66.

    Google Scholar 

  3. Glazer ES, Hornbrook MC, Krouse RS. A meta-analysis of randomized trials: immediate stent placement vs. surgical bypass in the palliative management of malignant biliary obstruction. J Pain Symptom Manag. 2014;47(2):307–14.

    Article  Google Scholar 

  4. Siripun, A., Sripongpun, P., & Ovartlarnporn, B. Endoscopic ultrasound-guided biliary intervention in patients with surgically altered anatomy. World J Gastrointest Endosc. 2015;7(3):283–289. https://doi.org/10.4253/wjge.v7.i3.283

  5. Kahaleh M, Artifon EL, Perez-Miranda M, Gupta K, Itoi T, Binmoeller KF, Giovannini M. Endoscopic ultrasonography guided biliary drainage: summary of consortium meeting, May 7th, 2011, Chicago. World J Gastroenterol. 2013;19(9):1372–9.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Saad WE, Wallace MJ, Wojak JC, Kundu S, Cardella JF. Quality improvement guidelines for percutaneous transhepatic cholangiography, biliary drainage, and percutaneous cholecystostomy. J Vasc Interv Radiol. 2010;21(6):789–95.

    Article  PubMed  Google Scholar 

  7. Umeda J, Itoi T, Tsuchiya T, Sofuni A, Itokawa F, Ishii K, et al. A newly designed plastic stent for EUS-guided hepaticogastrostomy: a prospective preliminary feasibility study (with videos). Gastrointest Endosc. 2015;82(2):390–6.

    Article  PubMed  Google Scholar 

  8. Dhir V, Bhandari S, Bapat M, Maydeo A. Comparison of EUS-guided rendezvous and precut papillotomy techniques for biliary access (with videos). Gastrointest Endosc. 2012;75(2):354–9.

    Article  PubMed  Google Scholar 

  9. Kawakubo K, Isayama H, Sasahira N, Nakai Y, Kogure H, Hamada T, et al. Clinical utility of an endoscopic ultrasound-guided rendezvous technique via various approach routes. Surg Endosc. 2013;27(9):3437–43.

    Article  PubMed  Google Scholar 

  10. Dhir V, Bhandari S, Bapat M, Joshi N, Vivekanandarajah S, Maydeo A. Comparison of transhepatic and extrahepatic routes for EUS-guided rendezvous procedure for distal CBD obstruction. United European Gastroenterol J. 2013;1(2):103–8.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Khashab MA, Valeshabad AK, Afghani E, Singh VK, Kumbhari V, Messallam A, et al. A comparative evaluation of EUS-guided biliary drainage and percutaneous drainage in patients with distal malignant biliary obstruction and failed ERCP. Dig Dis Sci. 2015;60(2):557–65.

    Article  PubMed  Google Scholar 

  12. Dhir V, Kwek BEA, Bhandari S, Bapat M, Maydeo A. EUS-guided biliary rendezvous using a short hydrophilic guidewire. J Interv Gastroenterol. 2011;1(4):153.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Dhir V, Itoi T, Khashab MA, Park DH, Teoh AYB, Attam R, et al. Multicenter comparative evaluation of endoscopic placement of expandable metal stents for malignant distal common bile duct obstruction by ERCP or EUS-guided approach. Gastrointest Endosc. 2015;81(4):913–23.

    Article  PubMed  Google Scholar 

  14. Shah JN, Marson F, Weilert F, Bhat YM, Nguyen-Tang T, Shaw RE, Binmoeller KF. Single-operator, single-session EUS-guided anterograde cholangiopancreatography in failed ERCP or inaccessible papilla. Gastrointest Endosc. 2012;75(1):56–64.

    Article  PubMed  Google Scholar 

  15. Park DH, Jeong SU, Lee BU, Lee SS, Seo DW, Lee SK, Kim MH. Prospective evaluation of a treatment algorithm with enhanced guidewire manipulation protocol for EUS-guided biliary drainage after failed ERCP (with video). Gastrointest Endosc. 2013;78(1):91–101.

    Article  PubMed  Google Scholar 

  16. Ogura T, Sano T, Onda S, Imoto A, Masuda D, Yamamoto K, et al. Endoscopic ultrasound-guided biliary drainage for right hepatic bile duct obstruction: novel technical tips. Endoscopy. 2015;47(1):72–5.

    PubMed  Google Scholar 

  17. Artifon EL, Marson FP, Gaidhane M, Kahaleh M, Otoch JP. Hepaticogastrostomy or choledochoduodenostomy for distal malignant biliary obstruction after failed ERCP: is there any difference? Gastrointest Endosc. 2015;81(4):950–9.

    Article  PubMed  Google Scholar 

  18. Poincloux L, Rouquette O, Buc E, Privat J, Pezet D, Dapoigny M, et al. Endoscopic ultrasound-guided biliary drainage after failed ERCP: cumulative experience of 101 procedures at a single center. Endoscopy. 2015;47(9):794–801.

    Article  PubMed  Google Scholar 

  19. Prachayakul V, Aswakul P. Endoscopic ultrasound-guided biliary drainage as an alternative to percutaneous drainage and surgical bypass. World J Gastrointest Endosc. 2015;7(1):37–44.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Iwashita T, Yasuda I, Mukai T, Iwata K, Ando N, Doi S, et al. EUS-guided rendezvous for difficult biliary cannulation using a standardized algorithm: a multicenter prospective pilot study (with videos). Gastrointest Endosc. 2016;83(2):394–400.

    Article  PubMed  Google Scholar 

  21. Kim YS, Gupta K, Mallery S, Li R, Kinney T, Freeman ML. Endoscopic ultrasound rendezvous for bile duct access using a transduodenal approach: cumulative experience at a single center. A case series. Endoscopy. 2010;42(6):496.

    Article  CAS  PubMed  Google Scholar 

  22. Ogura T, Higuchi K. Technical tips of endoscopic ultrasound-guided choledochoduodenostomy. World J Gastroenterol: WJG. 2015;21(3):820–8.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Tsuyuguchi T, Itoi T, Takada T, Strasberg SM, Pitt HA, Kim MH, et al. TG13 indications and techniques for gallbladder drainage in acute cholecystitis (with videos). J Hepatobiliary Pancreat Sci. 2013;20(1):81–8.

    Article  PubMed  Google Scholar 

  24. de la Serna-Higuera C, Pérez-Miranda M, Gil-Simón P, Ruiz-Zorrilla R, Diez-Redondo P, Alcaide N, et al. EUS-guided transenteric gallbladder drainage with a new fistula-forming, lumen-apposing metal stent. Gastrointest Endosc. 2013;77(2):303–8.

    Article  PubMed  Google Scholar 

  25. Kawakubo K, Isayama H, Kato H, Itoi T, Kawakami H, Hanada K, et al. Multicenter retrospective study of endoscopic ultrasound-guided biliary drainage for malignant biliary obstruction in Japan. J Hepatobiliary Pancreat Sci. 2014;21(5):328–34.

    Article  PubMed  Google Scholar 

  26. Dhir V, Artifon EL, Gupta K, Vila JJ, Maselli R, Frazao M, Maydeo A. Multicenter study on endoscopic ultrasound-guided expandable biliary metal stent placement: choice of access route, direction of stent insertion, and drainage route. Dig Endosc. 2014;26(3):430–5.

    Article  PubMed  Google Scholar 

  27. Gupta K, Perez-Miranda M, Kahaleh M, Artifon EL, Itoi T, Freeman ML, et al. Endoscopic ultrasound-assisted bile duct access and drainage: multicenter, long-term analysis of approach, outcomes, and complications of a technique in evolution. J Clin Gastroenterol. 2014;48(1):80–7.

    Article  PubMed  Google Scholar 

  28. Vila JJ, Pérez-Miranda M, Vazquez-Sequeiros E, Abadia MAS, Pérez-Millán A, González-Huix F, et al. Initial experience with EUS-guided cholangiopancreatography for biliary and pancreatic duct drainage: a Spanish national survey. Gastrointest Endosc. 2012;76(6):1133–41.

    Article  PubMed  Google Scholar 

  29. Itoi T, Sofuni A, Itokawa F, Tsuchiya T, Kurihara T, Ishii K, et al. Endoscopic ultrasonography-guided biliary drainage. J Hepatobiliary Pancreat Sci. 2010;17(5):611–6.

    Article  PubMed  Google Scholar 

  30. Khashab MA, DeWitt J. Treatment and prevention of wire shearing during EUS-guided biliary drainage. Gastrointest Endosc. 2012;76(4):921–3.

    Article  PubMed  Google Scholar 

  31. Iwashita T, Lee JG, Shinoura S, Nakai Y, Park DH, Muthusamy VR, Chang KJ. Endoscopic ultrasound-guided rendezvous for biliary access after failed cannulation. Endoscopy. 2012;44(1):60–5.

    Article  CAS  PubMed  Google Scholar 

  32. Iwashita T, Doi S, Yasuda I. Endoscopic ultrasound-guided biliary drainage: a review. Clin J Gastroenterol. 2014;7(2):94–102.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Paik WH, Park DH, Choi CJ, Choi JH, Lee SS, Seo DW, Lee SK, et al. Simplified fistula dilation technique and modified stent deployment maneuver for EUS-guided hepaticogastrostomy. World J Gastroenterol. 2014;20(17):5051–9.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Itoi T, Binmoeller KF. EUS-guided choledochoduodenostomy by using a biflanged lumen-apposing metal stent. Gastrointest Endosc. 2014;79(5):715.

    Article  PubMed  Google Scholar 

  35. Perez-Miranda M, De la Serna Higuera C, Gil-Simon P, Hernandez V, Diez-Redondo P, Fernandez-Salazar L. EUS-guided choledochoduodenostomy with lumen-apposing metal stent after failed rendezvous in synchronous malignant biliary and gastric outlet obstruction (with video). Gastrointest Endosc. 2014;80(2):342–4.

    Article  PubMed  Google Scholar 

  36. Brückner S, Arlt A, Hampe J. Endoscopic ultrasound-guided biliary drainage using a lumen-apposing self-expanding metal stent: a case series. Endoscopy. 2015;47(9):858–61.

    Article  PubMed  Google Scholar 

  37. Maluf-Filho F, Retes FA, Neves CZ, Sato CFM, Kawaguti FS, Jureidini R, et al. Transduodenal endosonography-guided biliary drainage and duodenal stenting for palliation of malignant obstructive jaundice and duodenal obstruction. JOP J Pancreas. 2012;13(2):210–4.

    Google Scholar 

  38. Hara K, Yamao K, Niwa Y, Sawaki A, Mizuno N, Hijioka S, et al. Prospective clinical study of EUS-guided choledochoduodenostomy for malignant lower biliary tract obstruction. Am J Gastroenterol. 2011;106(7):1239–45.

    Article  PubMed  Google Scholar 

  39. Ogura T, Kurisu Y, Masuda D, Imoto A, Hayashi M, Malak M, et al. Novel method of endoscopic ultrasound-guided hepaticogastrostomy to prevent stent dysfunction. J Gastroenterol Hepatol. 2014;29(10):1815–21.

    Article  PubMed  Google Scholar 

  40. Song TJ, Lee SS, Park DH, Seo DW, Lee SK, Kim MH. Preliminary report on a new hybrid metal stent for EUS-guided biliary drainage (with videos). Gastrointest Endosc. 2014;80(4):707–11.

    Article  PubMed  Google Scholar 

  41. Artifon EL, Aparicio D, Paione JB, Lo SK, Bordini A, Rabello C, et al. Biliary drainage in patients with unresectable, malignant obstruction where ERCP fails: endoscopic ultrasonography-guided choledochoduodenostomy versus percutaneous drainage. J Clin Gastroenterol. 2012;46(9):768–74.

    Article  PubMed  Google Scholar 

  42. Bapaye A, Dubale N, Aher A. Comparison of endosonography-guided vs. percutaneous biliary stenting when papilla is inaccessible for ERCP. United European Gastroenterol J. 2013;1(4):285–93.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Tapping CR, Byass OR, Cast JEI. Percutaneous transhepatic biliary drainage (PTBD) with or without stenting—complications, re-stent rate and a new risk stratification score. Eur Radiol. 2011;21(9):1948–55.

    Article  CAS  PubMed  Google Scholar 

  44. Yoon WJ, Brugge WR. EUS-guided biliary rendezvous: EUS to the rescue. Gastrointest Endosc. 2012;75(2):360–1.

    Article  PubMed  Google Scholar 

  45. Hara K, Yamao K, Hijioka S, Mizuno N, Imaoka H, Tajika M, et al. Prospective clinical study of endoscopic ultrasound-guided choledochoduodenostomy with direct metallic stent placement using a forward-viewing echoendoscope. Endoscopy. 2012;45(5):392–6.

    Google Scholar 

  46. Park DH, Jang JW, Lee SS, Seo DW, Lee SK, Kim MH. EUS-guided biliary drainage with transluminal stenting after failed ERCP: predictors of adverse events and long-term results. Gastrointest Endosc. 2011;74(6):1276–84.

    Article  PubMed  Google Scholar 

  47. Maranki J, Hernandez AJ, Arslan B, Jaffan AA, Angle JF, Shami VM, Kahaleh M. Interventional endoscopic ultrasound-guided cholangiography: long-term experience of an emerging alternative to percutaneous transhepatic cholangiography. Endoscopy. 2009;41(6):532–8.

    Article  CAS  PubMed  Google Scholar 

  48. Bories E, Pesenti C, Caillol F, Giovannini M. Endoscopic ultrasound-guided biliary procedures: report of 38 cases. Endoscopy. 2008;40(Suppl 1):A55.

    Google Scholar 

  49. Doctor N, Dick R, Rai R, Dafnios N, Salamat A, Whiteway H, et al. Results of percutaneous plastic stents for malignant distal biliary obstruction following failed endoscopic stent insertion and comparison with current literature on expandable metallic stents. Eur J Gastroenterol Hepatol. 1999;11(7):775–80.

    Article  CAS  PubMed  Google Scholar 

  50. Beissert M, Wittenberg G, Sandstede J, Beer M, Tschammler A, Burghardt W, et al. Metallic stents and plastic endoprostheses in percutaneous treatment of biliary obstruction. Z Gastroenterol. 2002;40(7):503–10.

    Article  CAS  PubMed  Google Scholar 

  51. Kühn JP, Busemann A, Lerch MM, Heidecke CD, Hosten N, Puls R. Percutaneous biliary drainage in patients with nondilated intrahepatic bile ducts compared with patients with dilated intrahepatic bile ducts. Am J Roentgenol. 2010;195(4):851–7.

    Article  Google Scholar 

  52. Bornman P, Tobias R, Harries-Jones EP, Stiegmann G, Terblanche J. Prospective controlled trial of transhepatic biliary endoprosthesis versus bypass surgery for incurable carcinoma of head of pancreas. Lancet. 1986;327(8472):69–71.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Gastroenterology, Baldota Institute of Digestive Sciences, Global Hospital, 3rd Floor, Hospital Avenue, Dr E Borges Road, Parel, Mumbai, Maharashtra, India

    Vinay Dhir & Amit Maydeo

  2. Department of Gastroenterology, Mercy Hospital, Minnesota Gastroenterology, Minneapolis, MN, USA

    Irfan Sandozi

Authors
  1. Vinay Dhir
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Irfan Sandozi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Amit Maydeo
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Vinay Dhir .

Editor information

Editors and Affiliations

  1. Advanced Endoscopy, Digestive Health Center, Section of Gastroenterology & Hepatology, Medical College of Georgia, Augusta University, Augusta, Georgia, USA

    Subbaramiah Sridhar

  2. Division of Gastroenterology-Hepatology, University of Connecticut Health Center, Farmington, Connecticut, USA

    George Y. Wu

Rights and permissions

Reprints and permissions

Copyright information

© 2018 Springer International Publishing AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Dhir, V., Sandozi, I., Maydeo, A. (2018). Endoscopic Ultrasound-Guided Biliary Access and Drainage. In: Sridhar, S., Wu, G. (eds) Diagnostic and Therapeutic Procedures in Gastroenterology. Clinical Gastroenterology. Humana Press, Cham. https://doi.org/10.1007/978-3-319-62993-3_38

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-62993-3_38

  • Published:

  • Publisher Name: Humana Press, Cham

  • Print ISBN: 978-3-319-62991-9

  • Online ISBN: 978-3-319-62993-3

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation