Recent progress in endoscopic ultrasonography guided biliary intervention.

Endoscopic biliary intervention is undergoing daily advances, especially in the area of endoscopic ultrasonography (EUS) guided procedures. Recently reported EUS-guided interventions include biliary drainage (BD), biliary cannulation and gallbladder drainage (GBD). A recent large-scale retrospective study showed clinical results of EUS-BD as salvage therapy, and reported the safety of covered metallic stents for preventing peritonitis due to bile leaks. There are two routes of EUS-BD: trans-gastric and duodenal. The indications for use of the trans-gastric route, called hepaticogastrostomy (HGS), are an impossible or a failed biliary approach. One recent advance in HGS is the development of a specific metallic stent for this procedure. The trans-duodenal route, called choledochoduodenostomy (CDS), is indicated for failed biliary cannulation cases as a salvage technique. However, results of EUS-CDS as a first-line therapy have been reported from Japan. EUS-guided biliary cannulation, rendezvous technique (EUS-RV) was also indicated as a technique for failed selective cannulation. The success rate of EUS-RV was reported to be 70-80%, but a recent large-scale study showed a 98.3% success rate and superiority to precutting. The tip was using short hydrophilic guide wire, the study reported. EUS-GBD is a new alternate method of management for cholecystitis. A randomized study comparing EUS-GBD and percutaneous gallbladder drainage (PTGBD) was one of most impressive articles in this area. In this article, the authors showed no inferiority of EUS-GBD to PTGBD in efficacy and safety. Other recent progress include newly developed specific SEMS designs. There is no standard technique of EUS-guided biliary intervention; we should establish these procedures.