Endoscopic ultrasound-guided biliary drainage: an update.

OPINION STATEMENT: Endoscopic retrograde cholangiopancreatography (ERCP) is currently the preferred procedure for biliary drainage in both benign and malignant obstructions. While ERCP is successful in approximately 95 % of cases, a small subset of cases are unsuccessful due to variant anatomy, ampullary pathology, or malignant luminal obstruction. Endoscopic ultrasound-guided biliary drainage (EUS-BD) is a promising route for biliary decompression that provides multiple advantages over percutaneous and surgical biliary drainage. Multiple retrospective as well as some prospective studies have shown EUS-BD to be safe and effective. Based on the current literature, the cumulative success rate is 84-93 %, regardless of the approach, with an overall complication rate of 16-35 %. EUS-BD appears to a viable therapeutic modality for failed ERCP when performed by highly skilled advanced endoscopists at tertiary centers with expertise in both echo-endoscopy and biliary endoscopy. Larger prospective multicenter randomized comparative studies are needed to further define indications, outcomes, and complications.