A multi-institution consensus on how to perform EUS-guided biliary drainage for malignant biliary obstruction

Jintao Guo, Marc Giovannini, Anand V Sahai, Adrian Saftoiu, Christoph F Dietrich, Erwin Santo, Pietro Fusaroli, Ali A Siddiqui, Manoop S Bhutani, Anthony Yuen Bun Teoh, Atsushi Irisawa, Brenda Lucia Arturo Arias, Chalapathi Rao Achanta, Christian Jenssen, Dong-Wan Seo, Douglas G Adler, Evangelos Kalaitzakis, Everson Artifon, Fumihide Itokawa, Jan Werner PoleyGirish Mishra, Khek Yu Ho, Hsiu-Po Wang, Hussein Hassan Okasha, Jesse Lachter, Juan J Vila, Julio Iglesias-Garcia, Kenji Yamao, Kenjiro Yasuda, Kensuke Kubota, Laurent Palazzo, Luis Carlos Sabbagh, Malay Sharma, Mitsuhiro Kida, Mohamed El-Nady, Nam Q Nguyen, Peter Vilmann, Pramod Kumar Garg, Praveer Rai, Shuntaro Mukai, Silvia Carrara, Sreeram Parupudi, Subbaramiah Sridhar, Sundeep Lakhtakia, Surinder S Rana, Takeshi Ogura, Todd H Baron, Vinay Dhir, Siyu Sun

Abstract

Background and Objectives: EUS-guided biliary drainage (EUS-BD) was shown to be useful for malignant biliary obstruction (MBO). However, there is lack of consensus on how EUS-BD should be performed.

Methods: This was a worldwide multi-institutional survey among members of the International Society of EUS conducted in February 2018. The survey consisted of 10 questions related to the practice of EUS-BD.

Results: Forty-six endoscopists of them completed the survey. The majority of endoscopists felt that EUS-BD could replace percutaneous transhepatic biliary drainage after failure of ERCP. Among all EUS-BD methods, the rendezvous stenting technique should be the first choice. Self-expandable metal stents (SEMSs) were recommended by most endoscopists. For EUS-guided hepaticogastrostomy (HGS), superiority of partially-covered SEMS over fully-covered SEMS was not in agreement. 6-Fr cystotomes were recommended for fistula creation. During the HGS approach, longer SEMS (8 or 10 cm) was recommended. During the choledochoduodenostomy approach, 6-cm SEMS was recommended. During the intrahepatic (IH) approach, the IH segment 3 was recommended.

Conclusion: This is the first worldwide survey on the practice of EUS-BD for MBO. There were wide variations in practice, and randomized studies are urgently needed to establish the best approach for the management of this condition.

OriginalsprogEngelsk
TidsskriftEndoscopic Ultrasound
Vol/bind7
Udgave nummer6
Sider (fra-til)356-365
Antal sider10
ISSN2303-9027
DOI
StatusUdgivet - 12 dec. 2018

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