ENDOSONOGRAPHY‐GUIDED BILIARY DRAINAGE

Abstract

Endoscopic biliary drainage (e.g. endoscopic biliary stenting [EBS]) is the treatment of choice in the management of obstructive jaundice due not only because of its lesser invasiveness and greater safety as compared with surgical drainage or percutaneous transhepatic biliary drainage (PTBD), but also due to its ability to maintain the physiological flow of bile. EBS, however, is not always possible, and surgical drainage or PTBD have been performed in such cases with difficult cannulation of the bile duct or difficult intubation of the duodenum with a duodenoscope during endoscopic retrograde cholangiopancreatography (ERCP). Recently, the role of endoscopic ultrasonography (EUS), or endosonography (ES), has expanded from simply obtaining cross‐sectional images of the gut wall or surrounding organs and tissue samples by fine‐needle aspiration cytology/biopsy to therapeutic applications. Endosonography‐guided biliary drainage (ESBD) is one of such therapeutic applications of ES and reports on this procedure are increasing. In the present article, technical aspects and the current status of ESBD are discussed. As in EBS, ESBD makes it possible to recover physiological bile flow without pain following the procedure. Therefore, ESBD is expected to soon be widely accepted as a new option for difficult cases of not only EBS but also PTBD with obstructive jaundice, and may become the treatment of choice in selected cases. Development of relevant devices will expand its indications and accelerate its spread.