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Current Gastroenterology Reports
Published in: Current Gastroenterology Reports 12/2020

01-12-2020 | Ultrasound | Endoscopy and Surgery (S Komanduri, Section Editor)

Advances in Biliary Access

Authors: Abdul H. El Chafic, Janak N. Shah

Published in: Current Gastroenterology Reports | Issue 12/2020

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Abstract

Purpose of Review

Bile duct cannulation using conventional techniques fails in up to 16% of endoscopic retrograde cholangiopancreatography (ERCP) procedures. Advanced techniques to gain biliary access include ERCP-based maneuvers, and newer endoscopic ultrasound (EUS)–guided interventions. In this article, we review the evidence supporting the use of various ERCP and EUS techniques for biliary access, as well as studies comparing these different techniques.

Recent Findings

In comparative studies, biliary access after failed conventional cannulation was more successful with EUS-rendezvous compared to precut papillotomy. EUS-guided drainage compares favorably with percutaneous drainage with respect to clinical success, safety profile, and cost-efficiency. Recent randomized trials comparing EUS to ERCP drainage in malignant obstruction have found similar success rates between these techniques.

Summary

EUS-guided techniques compare favorably to ERCP-based methods for biliary access and drainage. The advent of newer technologies to facilitate interventional EUS may further change current treatment approaches.
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Metadata
Title
Advances in Biliary Access
Authors
Abdul H. El Chafic
Janak N. Shah
Publication date
01-12-2020
Publisher
Springer US
Published in
Current Gastroenterology Reports / Issue 12/2020
Print ISSN: 1522-8037
Electronic ISSN: 1534-312X
DOI
https://doi.org/10.1007/s11894-020-00800-3

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