Abstract
Endoscopic ultrasound/ultrasonography‐guided biliary drainage (EUS‐BD) is a relatively new modality for biliary drainage after failed or difficult transpapillary biliary cannulation. Despite its clinical utility, EUS‐BD can be complicated by severe adverse events such as bleeding, perforation, and peritonitis. The aim of this paper is to provide practice guidelines for safe performance of EUS‐BD as well as safe introduction of the procedure to non‐expert centers. The guidelines comprised patient–intervention–comparison–outcome‐formatted clinical questions (CQs) and questions (Qs), which are background statements to facilitate understanding of the CQs. A literature search was performed using the PubMed and Cochrane Library databases. Statement, evidence level, and strength of recommendation were created according to the GRADE system. Four committees were organized: guideline creation, expert panelist, evaluation, and external evaluation committees. We developed 13 CQs (methods, device selection, supportive treatment, management of adverse events, education and ethics) and six Qs (definition, indication, outcomes and adverse events) with statements, evidence levels, and strengths of recommendation. The guidelines explain the technical aspects, management of adverse events, and ethics of EUS‐BD and its introduction to non‐expert institutions.
Highlights
Endoscopic biliary drainage for obstructive jaundice and acute cholangitis includes biliary stenting and endoscopic nasobiliary drainage by endoscopic retrograde cholangiopancreatography (ERCP). These techniques cannot be applied in some patients with difficult or impossible biliary cannulation, gastric outlet obstruction, or a surgically altered anatomy
Since Wiersema et al [1] first reported endoscopic ultrasound (EUS)-guided cholangiopancreatography in 1996, several modifications of EUSguided biliary drainage (EUS-BD), such as EUS-guided bilioduodenal anastomosis [2], which creates a fistula between the common bile duct and duodenum, have been made, and the use of this technique in clinical practice is increasing rapidly
Because the guidelines focus on the technical aspects of EUS-BD, members of the guideline creation and expert panelist committees were selected from among gastroenterologists with expertise in endoscopy and interventional radiology (IVR)
Summary
Endoscopic biliary drainage for obstructive jaundice and acute cholangitis includes biliary stenting and endoscopic nasobiliary drainage by endoscopic retrograde cholangiopancreatography (ERCP) These techniques cannot be applied in some patients with difficult or impossible biliary cannulation, gastric outlet obstruction, or a surgically altered anatomy. The techniques and devices require further improvement for safe and widespread use of EUS-BD, for which the current guidelines provide critical information. The purpose of these guidelines is to provide information on the safety of EUS-BD and on the methods for its introduction to more institutions, with the aim of improving clinical practice and promoting safe performance of the technique.
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