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Advances in Biliary Access

  • Endoscopy and Surgery (S Komanduri, Section Editor)
  • Published:
Current Gastroenterology Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

Bile duct cannulation using conventional techniques fails in up to 16% of endoscopic retrograde cholangiopancreatography (ERCP) procedures. Advanced techniques to gain biliary access include ERCP-based maneuvers, and newer endoscopic ultrasound (EUS)–guided interventions. In this article, we review the evidence supporting the use of various ERCP and EUS techniques for biliary access, as well as studies comparing these different techniques.

Recent Findings

In comparative studies, biliary access after failed conventional cannulation was more successful with EUS-rendezvous compared to precut papillotomy. EUS-guided drainage compares favorably with percutaneous drainage with respect to clinical success, safety profile, and cost-efficiency. Recent randomized trials comparing EUS to ERCP drainage in malignant obstruction have found similar success rates between these techniques.

Summary

EUS-guided techniques compare favorably to ERCP-based methods for biliary access and drainage. The advent of newer technologies to facilitate interventional EUS may further change current treatment approaches.

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Authors and Affiliations

  1. Department of Gastroenterology, Ochsner Health – New Orleans, 1514 Jefferson Hwy, New Orleans, LA, 70121, USA

    Abdul H. El Chafic & Janak N. Shah

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  1. Abdul H. El Chafic
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  2. Janak N. Shah
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Correspondence to Janak N. Shah.

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El Chafic, A.H., Shah, J.N. Advances in Biliary Access. Curr Gastroenterol Rep 22, 62 (2020). https://doi.org/10.1007/s11894-020-00800-3

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