Endoscopic Ultrasound-Guided Biliary Drainage for Benign Biliary Diseases
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초록
Although endoscopic retrograde cholangiopancreatography (ERCP) is the first-line treatment for benign biliary diseases, thisprocedure is technically diffcult in some conditions such as a surgically altered anatomy and gastric outlet obstruction. After a failedERCP, a surgical or a percutaneous approach is selected as a rescue procedure; however, various endoscopic ultrasound (EUS)-guidedinterventions are increasingly utilized in pancreatobiliary diseases, including EUS-guided rendezvous for failed biliary cannulation,EUS-guided antegrade treatment for stone management, and EUS-guided hepaticogastrostomy for anastomotic strictures in patientswith a surgically altered anatomy. There are some technical hurdles in EUS-guided interventions for benign biliary diseases owing to thediffculty in puncturing a relatively small bile duct and in subsequent guidewire manipulation, as well as the lack of dedicated devices. A recent major advancement in this field is the introduction of a 2-step approach, in which EUS-guided drainage is placed in thefirst session and antegrade treatment is performed in subsequent sessions. This approach allows the use of various techniques such asmechanical lithotripsy and cholangioscopy without a risk of bile leak. In summary, EUS-guided interventions are among the treatmentoptions for benign biliary diseases; however, standardization of the procedure and development of a treatment algorithm are needed.
Abstract
Although endoscopic retrograde cholangiopancreatography (ERCP) is the first-line treatment for benign biliary diseases, thisprocedure is technically diffcult in some conditions such as a surgically altered anatomy and gastric outlet obstruction. After a failedERCP, a surgical or a percutaneous approach is selected as a rescue procedure; however, various endoscopic ultrasound (EUS)-guidedinterventions are increasingly utilized in pancreatobiliary diseases, including EUS-guided rendezvous for failed biliary cannulation,EUS-guided antegrade treatment for stone management, and EUS-guided hepaticogastrostomy for anastomotic strictures in patientswith a surgically altered anatomy. There are some technical hurdles in EUS-guided interventions for benign biliary diseases owing to thediffculty in puncturing a relatively small bile duct and in subsequent guidewire manipulation, as well as the lack of dedicated devices. A recent major advancement in this field is the introduction of a 2-step approach, in which EUS-guided drainage is placed in thefirst session and antegrade treatment is performed in subsequent sessions. This approach allows the use of various techniques such asmechanical lithotripsy and cholangioscopy without a risk of bile leak. In summary, EUS-guided interventions are among the treatmentoptions for benign biliary diseases; however, standardization of the procedure and development of a treatment algorithm are needed.
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