Abstract
Endoscopic retrograde cholangiopancreatography (ERCP) is currently the standard of care for achieving endoscopic biliary and pancreatic duct access and is associated with high rates of technical success. However, in patients with failed ERCP, biliary drainage can be achieved either by percutaneous or surgical means, while pancreatic duct drainage can be achieved only by surgery. Percutaneous biliary drainage is often less preferred by patients as the external drainage tube causes inconvenience and frequently malfunctions. Surgical biliary drainage is associated with lower rates of recurrent biliary obstruction, but the invasive nature of the procedure causes more adverse events resulting in longer hospital stay. Consequently, EUS-guided biliary and pancreatic drainage procedures are gaining popularity as alternatives to percutaneous or surgical drainages of the respective organs. These procedures offer the option of internal drainage without the need of an external tube with potentially lower risk of adverse events. Promising outcomes have lead to the evaluation of EUS-guided biliary drainage as the primary drainage strategy in distal malignant biliary obstruction.This chapter will provide an overview on the various approaches, techniques and accessories, advantages and disadvantages, the reported outcomes as well as adverse events associated with these techniques.
Published Version
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