Background and Objectives: EUS-guided biliary drainage (EUS-BD) was shown to be useful for malignant biliary obstruction (MBO). However, there is lack of consensus on how EUS-BD should be performed.
Methods: This was a worldwide multi-institutional survey among members of the International Society of EUS conducted in February 2018. The survey consisted of 10 questions related to the practice of EUS-BD.
Results: Forty-six endoscopists of them completed the survey. The majority of endoscopists felt that EUS-BD could replace percutaneous transhepatic biliary drainage after failure of ERCP. Among all EUS-BD methods, the rendezvous stenting technique should be the first choice. Self-expandable metal stents (SEMSs) were recommended by most endoscopists. For EUS-guided hepaticogastrostomy (HGS), superiority of partially-covered SEMS over fully-covered SEMS was not in agreement. 6-Fr cystotomes were recommended for fistula creation. During the HGS approach, longer SEMS (8 or 10 cm) was recommended. During the choledochoduodenostomy approach, 6-cm SEMS was recommended. During the intrahepatic (IH) approach, the IH segment 3 was recommended.
Conclusion: This is the first worldwide survey on the practice of EUS-BD for MBO. There were wide variations in practice, and randomized studies are urgently needed to establish the best approach for the management of this condition.
Recommended CitationGuo, Jintao; Giovannini, Marc; Sahai, Anand V.; Saftoiu, Adrian; Dietrich, Christoph F.; Santo, Erwin; Fusaroli, Pietro; Siddiqui, Ali; Bhutani, Manoop S.; Bun Teoh, Anthony Yuen; Irisawa, Atsushi; Arturo Arias, Brenda Lucia; Achanta, Chalapathi Rao; Jenssen, Christian; Seo, Dong-Wan; Adler, Douglas G.; Kalaitzakis, Evangelos; Artifon, Everson; Itokawa, Fumihide; Poley, Jan Werner; Mishra, Girish; Ho, Khek Yu; Wang, Hsiu-Po; Okasha, Hussein Hassan; Lachter, Jesse; Vila, Juan J.; Iglesias-Garcia, Julio; Yamao, Kenji; Yasuda, Kenjiro; Kubota, Kensuke; Palazzo, Laurent; Sabbagh, Luis Carlos; Sharma, Malay; Kida, Mitsuhiro; El-Nady, Mohamed; Nguyen, Nam Q.; Vilmann, Peter; Garg, Pramod Kumar; Rai, Praveer; Mukai, Shuntaro; Carrara, Silvia; Parupudi, Sreeram; Sridhar, Subbaramiah; Lakhtakia, Sundeep; Rana, Surinder S; Ogura, Takeshi; Baron, Todd H.; Dhir, Vinay; and Sun, Siyu, "A multi-institution consensus on how to perform EUS-guided biliary drainage for malignant biliary obstruction." (2018). Division of Gastroenterology and Hepatology Faculty Papers. Paper 53.
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