ASIAN EUS CUP: Asian EUS Cup-02: Endoscopic ultrasound-guided biliary and vesicular drainage: Low complication rate in a tertiary center

BACKGROUND: Endoscopic ultrasound (EUS) allows bile duct drainage in case of endoscopic retrograde cholangiopancreatography (ERCP) failure or inaccessible papilla, during the same anesthetic time, as an alternative to delayed radiological drainage. Our study aims were to review indications, techniques, and early complications (<7 days) of biliary drainage by EUS as a second-line treatment after ERCP failure, including inaccessible papilla and failed ERCP. METHODS: This was a retrospective evaluation carried out between 2002 and 2016. RESULTS: Out of >8400 ERCPs performed during this period, 31 patients (68 years range 14–92) were included. 66% (19/29) had failed bile duct drainage due to neoplastic infiltration and the others had inaccessible papilla: roux-en-Y limb (3/10), duodenal stenosis (6/10), or stent (1/10). 65% were drained transgastrically and 35% through the bulb. Drainage was achieved by placing a transmural stent in 79% of cases, “rendezvous” in 14%, and anterograde access in 7%. Two gallbladder drainages were performed in inoperable patients with acute cholecystitis. Average procedural time was 68 min. There were four early complications, including pneumoperitoneum before CO(2) use, three stent migrations, or malposition, all of which treated endoscopically. CONCLUSIONS: EUS-guided biliary and vesicular drainage can be safely performed even in low rates of ERCP failures.