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Endosc Ultrasound. 2019 May-Jun;8(3):188-193. doi: 10.4103/eus.eus_57_18.

The underutilization of EUS-guided biliary drainage: Perception of endoscopists in the East and West.

Author information

Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul, South Korea.
Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
Department of Internal Medicine, Dankook University College of Medicine, South Korea.
Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, OH, USA.
Department of Medicine, University of California-Irvine, Orange, CA, USA.
Department of Internal Medicine, Soonchunhyang University School of Medicine, Cheonan, South Korea.
Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea.
Department of Gastroenterology, Nowon Eulji Medical Center, Eulji University, Seoul, South Korea.
Department of Internal Medicine, Inje University College of Medicine, Busan, South Korea.
Department of Gastroenterology, Aichi Cancer Center Hospital, Nagoya, Japan.
First Department of Internal Medicine, Gifu University Hospital, Gifu, Japan.
Department of Gastroenterology and Hepatology, Hospital Universitario Rio Hortega, Valladolid, Spain.
Department of Gastroenterology and Hepatology, University Hospital Ramon Y Cajal, IRYCIS, Madrid, Spain.
Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
Endoscopy Unit, Complejo Hospitalario de Navarra, Pamplona, Spain.
Division of Gastroenterology, Mount Auburn Hospital, Cambridge, MA, USA.
Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka, Japan.


Background and Objectives:

EUS-guided biliary drainage (EUS-BD) is increasingly utilized to manage unresectable malignant biliary obstruction after a failed ERCP. However, there is no data on how endoscopists perceive EUS-BD. The aim of this study was to investigate the perception of endoscopists on EUS-BD.

Patients and Methods:

A survey questionnaire of six topics with 22 survey statements was developed. A total of 17 pancreatobiliary endoscopists (10 from East and 7 from West) were invited to survey. The participants were asked to answer the multiple choice questionnaire and give comments. The opinions of the participants for individual survey statements were assessed using 5-point Likert scale.


All participants completed the survey. The endoscopists had a trend to perceive EUS-BD as a procedure indicated after a failed ERCP. Various EUS-BD methods were regarded as having different efficacy and safety. The superiority of EUS-BD over percutaneous transhepatic BD (PTBD) with regard to efficacy, procedure-related adverse events, and unscheduled re-intervention was not in agreement.


EUS-BD was not yet perceived as the initial procedure to relieve the unresectable malignant biliary obstruction. Various EUS-BD methods were regarded as having different efficacy and safety. The superiority of EUS-BD over PTBD was not in agreement. Refining the procedure, developing dedicated devices, and gaining expertise in the procedure are necessary to popularize EUS-BD.


Biliary drainage; endoscopic ultrasound; perception

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