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

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  • 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 Poley
  • Girish 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
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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.

Original languageEnglish
JournalEndoscopic Ultrasound
Issue number6
Pages (from-to)356-365
Number of pages10
Publication statusPublished - 12 Dec 2018

ID: 56501414