Endoscopic ultrasound-guided biliary interventions: an update on recent developments.

PURPOSE OF REVIEW: Endoscopic ultrasound (EUS)-guided biliary drainage procedures can be utilized in patients with biliary obstruction and incomplete drainage with prior interventions, in those whose ampulla is inaccessible (i.e. from surgically altered anatomy and malignant luminal obstruction), or in those who failed bile duct cannulation during endoscopic retrograde cholangiopancreatography. Improved techniques and accessories have streamlined these procedures; however, further investigation is required. The purpose of this review is to provide the highlights of the most recent literature on EUS-guided biliary drainage.

RECENT FINDINGS: Recent literature has demonstrated the effectiveness and safety of EUS-guided gallbladder drainage, both as a primary intervention in patients with cholecystitis who are unfit for urgent surgical intervention and as a secondary intervention to internalize biliary drainage after initial placement of a cholecystostomy catheter. EUS-guided bile duct drainage can be performed using various techniques. The optimal technique requires further study and may vary by clinical scenario.

SUMMARY: The role of EUS-guided biliary drainage continues to evolve. The most recent literature has attempted to clarify the optimal strategies and indications for employing the various EUS-guided biliary drainage techniques.