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CC BY 4.0 · Journal of Digestive Endoscopy 2023; 14(02): 074-087
DOI: 10.1055/s-0043-1768043
Guidelines

Society of Gastrointestinal Endoscopy of India Consensus Guidelines on Endoscopic Ultrasound-Guided Biliary Drainage: Part II (Technical Aspects)

Jayanta Samanta 
1   Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
,
Priyanka Udawat
2   School of EUS, Institute of Digestive and Liver Care, S. L. Raheja Hospital, Mumbai, Maharashtra, India
,
Sudipta Dhar Chowdhary
3   Department of Gastroenterology, Christian Medical College, Vellore, Tamil Nadu, India
,
Deepak Gunjan 
4   Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi, India
,
Praveer Rai 
5   Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute, Lucknow, Uttar Pradesh, India
,
Vikram Bhatia
6   Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India
,
Vikas Singla 
7   Department of Gastroenterology, Max Super Speciality Hospital, New Delhi, India
,
Saurabh Mukewar
8   Department of Gastroenterology, Midas Hospital, Nagpur, Maharashtra, India
,
Nilay Mehta
9   Department of Gastroenterology, Zydus Hospital, Ahmedabad, Gujrat, India
,
Chalapathi Rao Achanta 
10   Department of Gastroenterology, KIMS ICON Hospital, Vishakhapatnam, Andhra Pradesh, India
,
Ankit Dalal
11   Baldota Institute of Digestive Sciences, Global Hospital, Mumbai, Maharashtra, India
,
Manoj Kumar Sahu 
12   Institute of GI Sciences, Apollo Hospitals, Bhubaneshwar, Odisha, India
,
Avinash Balekuduru
13   Department of Gastroenterology, MS Ramaiah Medical college and Hospital, Bengaluru, Karnataka, India
,
Abhijit Bale 
14   Department of Medical Gastroenterology, Saptaghiri Institute of Medical Sciences, Bengaluru, Karnataka, India
,
Jahangir Basha
15   Asian Institute of Gastroenterology, AIG Hospitals, Hyderabad, Telangana, India
,
Mathew Philip 
16   Department of Gastroenterology, Lisie Hospital, Kochi, Kerala, India
,
Surinder Rana
1   Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
,
Rajesh Puri
17   Institute of Digestive and Hepatobiliary Sciences, Medanta Hospital, Gurugram, Haryana, India
,
Sundeep Lakhtakia 
15   Asian Institute of Gastroenterology, AIG Hospitals, Hyderabad, Telangana, India
,
Vinay Dhir
2   School of EUS, Institute of Digestive and Liver Care, S. L. Raheja Hospital, Mumbai, Maharashtra, India
,
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Abstract

Endoscopic management of bile duct obstruction is a key aspect in gastroenterology practice and has evolved since the first description of biliary cannulation by McCune et al in 1968. Over many decades, the techniques and accessories have been refined, and currently, the first-line management for extrahepatic biliary obstruction is endoscopic retrograde cholangiopancreatography (ERCP). However, even in expert hands, the success rate of ERCP reaches up to 95%. In almost 4 to 16% cases, failure to cannulate the bile duct may necessitate other alternatives such as surgical bypass or, more commonly, percutaneous transhepatic biliary drainage (PTBD). While surgery is associated with high morbidity and mortality, PTBD has a very high reintervention and complication rate (∼80%) and poor quality of life. Almost parallelly, endoscopic ultrasound (EUS) has come a long way from a mere diagnostic tool to a substantial therapeutic option in various pancreaticobiliary diseases. Biliary drainage using EUS-guidance (EUS-BD) has gained momentum since the first report published by Giovannini et al in 2001. The concept of accessing the bile duct through a different route than the papilla, circumventing the shortcomings of PTBD, and sometimes bypassing the actual obstruction have enthused a lot of interest in this novel strategy. The three key methods of EUS-BD entail transluminal, antegrade, and rendezvous approach. Over the past decade, with growing experience, EUS-BD has been found to be equivalent to ERCP or PTBD for malignant obstruction with better success rates. EUS-BD, however, is not devoid of adverse events and can carry fatal adverse events. However, neither the technique of EUS-BD nor the accessories and stents for EUS-BD have been standardized. Additionally, different countries and regions have different availability of the accessories, making generalizability a difficult task. Thus, technical aspects of this evolving therapy need to be outlined. For these reasons, Society of Gastrointestinal Endoscopy of India (SGEI) deemed it appropriate to develop technical consensus statements for performing safe and successful EUS-BD.

Keywords

biliary drainage - endoscopic ultrasound - obstructive jaundice

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Publication History

Article published online:
24 April 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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