EUS-Guided Biliary Drainage (EUS-BD)
EUS-guided biliary drainage (EUS-BD) has emerged as a technique for gaining biliary access when ERCP fails. ERCP remains the first-line method for accessing the bile duct. ERCP fails in 5%–10% of cases due to inaccessible papilla or inability to cannulate the papilla.Reasons for ERCP failure include altered anatomy, ampullary distortion, periampullary diverticulum, gastric outlet obstruction, or duodenal stents .Conventionally, percutaneous transhepatic biliary drainage (PTBD) has been performed when ERCP fails. However, PTBD is associated with high adverse event rates that are seen in up to 33% and include bleeding, bile leak, dislocation of the external catheter, recurrent infection, and acute cholangitis. Catheter-related morbidity from the external drainage are well known and may also worsen the patient’s quality of life.
Over the last decade, a wealth of data has surfaced demonstrating efficacy and safety of this technique. EUS-BD has several advantages. First, it is minimally invasive and can be performed directly after a failed ERCP in the same session by the same proceduralist. Second, drainage of both the intrahepatic and extrahepatic bile ducts may be achieved. Third, it is minimally invasive with minimal or no procedural pain. Fourth, as opposed to PTBD, there is no external drain that can dislocate or that limits patient’s daily activities. In addition, a short hospital stay (similar to ERCP) is expected, and the reported adverse event rate is far lower than for PTBD