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Endoscopy 2022; 54(03): 310-332
DOI: 10.1055/a-1738-6780
Technical Review

Therapeutic endoscopic ultrasound: European Society of Gastrointestinal Endoscopy (ESGE) Technical Review

Roy L. J. van Wanrooij  ‡   *
 1   Department of Gastroenterology and Hepatology, Amsterdam UMC, Vrije Universiteit Amsterdam, AGEM Institute, Amsterdam, The Netherlands
,
Michiel Bronswijk  ‡   *
 2   Department of Gastroenterology and Hepatology, Imelda General Hospital, Bonheiden, Belgium
 3   Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
,
Rastislav Kunda 
 4   Department of Surgery, Department of Gastroenterology and Hepatology, and Department of Advanced Interventional Endoscopy, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
,
Simon M. Everett
 5   Department of Gastroenterology and Hepatology, Leeds Teaching Hospital NHS Trust, Leeds, UK
,
Sundeep Lakhtakia
 6   Department of Medical Gastroenterology, Asian Institute of Gastroenterology Hospitals, Gachibowli, Hyderabad, India
,
Mihai Rimbas 
 7   Gastroenterology Department, Colentina Clinical Hospital, Bucharest, Romania
,
Tomas Hucl
 8   Department of Gastroenterology and Hepatology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
,
Abdenor Badaoui
 9   Department of Gastroenterology and Hepatology, Université catholique de Louvain, CHU UCL Namur, Yvoir, Belgium
,
Ryan Law
10   Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
,
Paolo Giorgio Arcidiacono
11   Pancreatobiliary Endoscopy and Endosonography Division, IRCCS San Raffaele Scientific Institute, Milan, Italy
,
Alberto Larghi
12   Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, and Center for Endoscopic Research Therapeutics and Training, Catholic University, Rome, Italy
,
Marc Giovannini
13   Paoli-Calmettes Institute, Department of Gastrointestinal Disease, Marseille, France
,
Mouen A. Khashab
14   Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland, USA
,
Kenneth F. Binmoeller
15   Interventional Endoscopy Services, California Pacific Medical Center, San Francisco, California, USA
,
Marc Barthet 
16   Department of Gastroenterology, Aix-Marseille Université, APHM, Hôpital Nord, Marseille, France
,
Manuel Pérez-Miranda 
17   Gastroenterology Department, Hospital Universitario Rio Hortega, Valladolid, Spain
,
Jeanin E. van Hooft 
18   Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, The Netherlands
,
Schalk W. van der Merwe
 3   Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
› Author Affiliations
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Main Recommendations

1 ESGE recommends a prolonged course of a prophylactic broad-spectrum antibiotic in patients with ascites who are undergoing therapeutic endoscopic ultrasound (EUS) procedures.
Strong recommendation, low quality evidence.

2 ESGE recommends placement of partially or fully covered self-expandable metal stents during EUS-guided hepaticogastrostomy for biliary drainage in malignant disease.
Strong recommendation, moderate quality evidence.

3 ESGE recommends EUS-guided pancreatic duct (PD) drainage should only be performed in high volume expert centers, owing to the complexity of this technique and the high risk of adverse events.
Strong recommendation, low quality evidence.

4 ESGE recommends a stepwise approach to EUS-guided PD drainage in patients with favorable anatomy, starting with rendezvous-assisted endoscopic retrograde pancreatography (RV-ERP), followed by antegrade or transmural drainage only when RV-ERP fails or is not feasible.
Strong recommendation, low quality evidence.

5 ESGE suggests performing transduodenal EUS-guided gallbladder drainage with a lumen-apposing metal stent (LAMS), rather than using the transgastric route, as this may reduce the risk of stent dysfunction.
Weak recommendation, low quality evidence.

6 ESGE recommends using saline instillation for small-bowel distension during EUS-guided gastroenterostomy.
Strong recommendation, low quality evidence.

7 ESGE recommends the use of saline instillation with a 19G needle and an electrocautery-enhanced LAMS for EUS-directed transgastric endoscopic retrograde cholangiopancreatography (EDGE) procedures.
Strong recommendation, low quality evidence.

8 ESGE recommends the use of either 15- or 20-mm LAMSs for EDGE, with a preference for 20-mm LAMSs when considering a same-session ERCP.
Strong recommendation, low quality evidence.

* Joint first authors




Publication History

Article published online:
03 February 2022

© 2022. European Society of Gastrointestinal Endoscopy. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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