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Year : 2018  |  Volume : 7  |  Issue : 6  |  Page : 356-365

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

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

Correspondence Address:
Dr. Siyu Sun
Endoscopy Center, ShengJing Hospital of China Medical University, No. 36, Sanhao Street, Shenyang 110004, Liaoning Province
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/eus.eus_53_18

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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.

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