Endoscopic ultrasonography-guided biliary drainage: an alternative to percutaneous transhepatic puncture

Abstract

Endoscopic retrograde cholangiopancreatography (ERCP) is the first-choice treatment for patients with obstructive jaundice. However, there are patients in whom bile duct access is not possible. In these patients, percutaneous transhepatic biliary drainage (PTBD) may be performed as an alternative biliary drainage method. PTBD is reportedly associated with a moderate mortality rate. In recent years, endoscopic ultrasonography-guided biliary drainage (EUS-BD) in patients with failed ERCP has been reported as an alternative to PTBD. EUS-BD is classified into three techniques: (1) EUS-guided choledocoduodenostomy (EUS-CDS); (2) EUS-guided hepatogastrostomy (EUS-HGS); and (3) EUS-guided antegrade (EUS-AG) approach. Herein, we focus on the current status of EUS-BD in light of these techniques.