Society of Gastrointestinal Endoscopy of India Consensus Guidelines on Endoscopic Ultrasound-Guided Biliary Drainage: Part I (Indications, Outcomes, Comparative Evaluations, Training)

Praveer Rai; Priyanka Udawat; Sudipta Dhar Chowdhary; Deepak Gunjan; Jayanta Samanta; Vikram Bhatia; Vikas Singla; Saurabh Mukewar; Nilay Mehta; Chalapathi Rao Achanta; Ankit Dalal; Manoj Kumar Sahu; Avinash Balekuduru; Abhijit Bale; Jahangir Basha; Mathew Philip; Surinder Rana; Rajesh Puri; Sundeep Lakhtakia; Vinay Dhir; India EUS Club

doi:10.1055/s-0043-1761591

Journal of Digestive Endoscopy, Table of Contents

CC BY 4.0 · Journal of Digestive Endoscopy 2023; 14(01): 030-040
DOI: 10.1055/s-0043-1761591

Guidelines

Society of Gastrointestinal Endoscopy of India Consensus Guidelines on Endoscopic Ultrasound-Guided Biliary Drainage: Part I (Indications, Outcomes, Comparative Evaluations, Training)

Praveer Rai

¹Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India

,

Priyanka Udawat

²Institute of Digestive and Liver Care, School of EUS, S. L. Raheja Hospital, Mumbai, Maharashtra, India

,

Sudipta Dhar Chowdhary

³Department of Gastroenterology, Christian Medical College, Vellore, Tamil Nadu, India

,

Deepak Gunjan

⁴Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi, India

,

Jayanta Samanta

⁵Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India

,

Vikram Bhatia

⁶Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India

,

Vikas Singla

⁷Department of Gastroenterology, Max Superspeciality Hospital, New Delhi, India

,

Saurabh Mukewar

⁸Midas Multispecialty Hospital, Nagpur, Maharashtra, India

,

Nilay Mehta

⁹Department of Gastroenterology, Zydus Hospital, Ahmedabad, Gujarat, India

,

Chalapathi Rao Achanta

¹⁰Department of Gastroenterology, KIMS ICON Hospital, Vishakhapatnam, Andhra Pradesh, India

,

Ankit Dalal

¹¹Baldota Institute of Digestive Sciences, Global Hospital, Mumbai, Maharashtra, India

,

Manoj Kumar Sahu

¹²Institute of GI Sciences, Apollo Hospitals, Bhubaneshwar, Orissa, India

,

Avinash Balekuduru

¹³Department of Gastroenterology, MS Ramaiah Medical College and Hospital, Bengaluru, Karnataka, India

,

Abhijit Bale

¹⁴Department of Medical Gastroenterology, Sapthagiri Institute of Medical Sciences, Bengaluru, Karnataka, India

,

Jahangir Basha

¹⁵Asian Institute of Gastroenterology, AIG Hospitals, Hyderabad, Telangana, India

,

Mathew Philip

¹⁶Department of Gastroenterology, Lisie Hospital, Kochi, Kerala, India

,

Surinder Rana

⁵Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India

,

Rajesh Puri

¹⁷Institute of Digestive and Hepatobiliary Sciences, Medanta Hospital, Gurugram, Haryana, India

,

Sundeep Lakhtakia

¹⁵Asian Institute of Gastroenterology, AIG Hospitals, Hyderabad, Telangana, India

,

Vinay Dhir

²Institute of Digestive and Liver Care, School of EUS, S. L. Raheja Hospital, Mumbai, Maharashtra, India

,

India EUS Club

› Author Affiliations

Abstract

Endoscopic management of bile duct obstruction is a key aspect in gastroenterology practice and has evolved since the first description of biliary cannulation by McCune et al in 1968. Over many decades, the techniques and accessories have been refined and currently, the first-line management for extrahepatic biliary obstruction is endoscopic retrograde cholangiopancreaticography (ERCP). However, even in expert hands the success rate of ERCP reaches up to 95%. In almost 4 to 16% cases, failure to cannulate the bile duct may necessitate other alternatives such as surgical bypass or more commonly percutaneous transhepatic biliary drainage (PTBD). While surgery is associated with high morbidity and mortality, PTBD has a very high reintervention and complication rate (∼80%) and poor quality of life. Almost parallelly, endoscopic ultrasound (EUS) has come a long way from a mere diagnostic tool to a substantial therapeutic option in various pancreatico-biliary diseases. Biliary drainage using EUS-guidance (EUS-BD) has gained momentum since the first report published by Giovannini et al in 2001. The concept of accessing the bile duct through a different route than the papilla, circumventing the shortcomings of PTBD and sometimes bypassing the actual obstruction have enthused a lot of interest in this novel strategy. The three key methods of EUS-BD entail transluminal, antegrade, and rendezvous approach. Over the past decade, with growing experience, EUS-BD has been found to be equivalent to ERCP or PTBD for malignant obstruction with better success rates.

EUS-BD, albeit, is not devoid of adverse events and can carry fatal adverse events. However, neither the technique of EUS-BD, nor the accessories and stents for EUS-BD have been standardized.

Additionally, different countries and regions have different availability of the accessories making generalizability a difficult task. Thus, technical aspects of this evolving therapy need to be outlined. For these reasons, the Society of Gastrointestinal Endoscopy India deemed it appropriate to develop technical consensus statements for performing safe and successful EUS-BD.

Keywords

biliary drainage - endoscopic ultrasound - obstructive jaundice

Full Text

References

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