Preoperative endoscopic ultrasound-guided biliary drainage for primary drainage in obstructive jaundice

ABSTRACT

Introduction

Endoscopic transpapillary approach by endoscopic retrograde cholangiopancreatography (ERCP) is the established technique for preoperative biliary drainage (PBD). Recently, endoscopic ultrasound-guided biliary drainage (EUS-BD) has been reported to be a useful alternative technique after ERCP fail. However, the optimal strategy remain controversial.

Area covered

This review summarizes the literature on EUS-BD techniques for PBD with a literature search using PubMed, Web of Science, and the Cochrane Central Register of Controlled Trials database between 2000 and 2023 using keywords for ‘preoperative biliary drainage’ and all types of EUS-BD techniques.

Expert opinion

As there is no consensus on the optimal EUS-BD technique for PBD, selection of the EUS-BD approach depends on the patient’s condition, the biliary obstruction site, the anastomosis after surgical intervention, and the preference of the endoscopist. However, we consider that EUS-HGS using a dedicated plastic stent may have some advantages in the adverse impact of surgical procedure because the location where the fistula is created by EUS-HGS is away from the site of the surgical procedure. Although there remain many issues that require further investigation, EUS-BD can be a feasible and safe alternative method of PBD for malignant biliary obstruction after ERCP fail.

KEYWORDS:

• Preoperative biliary drainage
• endoscopic transpapillary biliary drainage
• ERCP
• EUS-guided biliary drainage
• EUS-guided rendezvous technique
• EUS-guided choledochoduodenostomy
• EUS-guided hepaticogastrostomy
• EUS-guided antegrade stenting

Article highlights

• Although the benefit of PBD remains controversial when jaundice is mild and early surgical resection is possible, PBD is still considered to have an important role in clinical practice.

• EUS-BD is generally indicated for PBD in patients in whom transpapillary drainage by ERCP has failed.

• As there is no consensus on the optimal EUS-BD technique for PBD, selection of the EUS-BD approach depends on the patient’s condition, the biliary obstruction site, the anastomosis after surgical intervention, and the preference of the endoscopist.

• A LAMS is preferable to a conventional tubular biliary metal stent for PBD with EUS-CDS considering the effect on the surgical procedure due to the location of the stent placement.

• EUS-HGS may have advantages over EUS-CDS in the adverse impact of surgical procedure because the location where the fistula is created by EUS-HGS is away from the site of the surgical procedure.

• The disadvantage of PBD with EUS-AS is that there remains a risk of pancreatitis in the absence of pancreatic duct obstruction even with an uncovered metal stent, which should be avoided preoperatively.

• The two drainage methods, ERCP and EUS-BD, have comparable efficacy and safety in RCTs comparing ERCP and EUS-BD as primary drainage for obstructive jaundice.

• Although there remain many issues that require further investigation, EUS-BD can be a feasible and safe alternative method of PBD for malignant biliary obstruction after ERCP fail.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosure

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.