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Endosc Ultrasound. 2018 Nov-Dec;7(6):356-365. doi: 10.4103/eus.eus_53_18.

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

Author information

1
Endoscopy Center, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China.
2
Pathology Unit (Flora Poizat), Institute Paoli-Calmettes, Marseille, France.
3
Center Hospitalier de l'Université de Montréal, Montreal, Canada.
4
Department of Endoscopy, University of Medicine and Pharmacy, Craiova, Romania.
5
Medical Department II, Caritas Hospital, Bad Mergentheim, Germany.
6
Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel.
7
Department of Medical and Surgical Sciences, Gastroenterology Unit, Hospital of Imola, University of Bologna, Bologna, Italy.
8
Division of Gastroenterology and Hepatology, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
9
Department of Gastroenterology, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
10
Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong.
11
Department of Gastroenterology, Dokkyo Medical University, Mibu, Japan.
12
Surgical Clinical Gastroenterolgy, Universidad de Caldas, Manizales, Colombia.
13
Gastroenterologist at Queen's NRI Hospital, Visakhapatnam, Andhra Pradesh, India.
14
Krankenhaus Märkisch Oderland Strausberg, Wriezen, Germany.
15
Department of Internal Medicine, Division of Gastroenterology, University of Ulsan College of Medicine, Seoul, South Korea.
16
Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA.
17
Division of Endoscopy, Gastro Unit, Copenhagen University Hospital Herlev, Copenhagen, Denmark.
18
Department of Surgery, University of Sao Paulo, Sao Paulo, Brazil.
19
Department of Gastroenterology and Hepatology, Tokyo Adventist Hospital, Tokyo, Japan.
20
Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands.
21
Department of Gastroenterology, Wake Forest Baptist Health, Winston-Salem, North Carolina, USA.
22
Department of Medicine, National University of Singapore, Singapore, Singapore.
23
Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan, China.
24
Internal Medicine Department, Cairo University, Cairo, Egypt.
25
Rambam Health Care Campus, Haifa, Israel.
26
Endoscopy Unit, Complejo Hospitalario de Navarra, Pamplona, Spain.
27
Department of Gastroenterology and Hepatology, University Hospital of Santiago de Compostela, Spain.
28
Aichi Cancer Center Hospital, Nagoya, Japan.
29
Department of Gastroenterology, Kyoto Second Red Cross Hospital, Kyoto, Japan.
30
Department of Endoscopy, Yokohama City University School of Medicine, Yokohama, Japan.
31
Trocadero Clinic, Paris, France.
32
Clinica Reina Sofia, Bogota, Colombia.
33
Department of Gastroenterology, Jaswant Rai Specialty Hospital, Meerut, Uttar Pradesh, India.
34
Department of Gastroenterology, Kitasato University East Hospital, Sagamihara, Japan.
35
Internal Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt.
36
Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, North Terrace, Adelaide, Australia.
37
Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India.
38
Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.
39
Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan.
40
Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Research Hospital, Milan, Italy.
41
Texas Tech University Health Sciences Center, Lubbock, TX, USA.
42
Section of Gastroenterology/Hepatology, Augusta University, Augusta, GA, USA.
43
Asian Institute of Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, Telangana, India.
44
Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
45
2nd Department of Internal Medicine, Osaka Medical College, Osaka, Japan.
46
Division of Gastroenterology, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
47
Department of Gastroenterology, SL Raheja Hospital, Mumbai, Maharashtra, India.

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.

KEYWORDS:

Consensus; EUS-guided biliary drainage; questionnaire survey

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