Technical tips and recent development of endoscopic ultrasound‐guided choledochoduodenostomy

Various efforts to improve technical success rates and decrease adverse event rates have also been described in endoscopic ultrasound (EUS)‐guided choledochoduodenostomy (CDS). In particular, lumen‐apposing metal stents (LAMS) may open novel opportunities in EUS‐biliary drainage (BD). To date, various studies have been reported with EUS‐CDS using LAMS, so we should clarify the benefits and limitations of recent EUS‐CDS based on developments in both techniques and devices. In this review, we provide technical tips and describe recent developments in EUS‐CDS, along with a review of the recent literature (between 2015 and 2020). The overall technical success rate is 95.0% (939/988), and the overall clinical success rate is 97.0% (820/845). The most frequent adverse event is cholangitis or cholecystitis (24.5%, 27/110). According to previous review, pneumoperitoneum (28%, 9/34) or peritonitis associated with bile leak (23.5%, 8/34) was most commonly observed. This difference might be based on improvements in dilation devices or the use of covered metal stents. Several randomized controlled trials comparing EUS‐CDS and endoscopic retrograde cholangiopancreatography (ERCP) for malignant biliary obstruction have recently been reported. To summarize, overall technical success rates for ERCP and EUS‐CDS were 92.7% (101/109) and 91.1% (72/79), respectively (p = 0.788). Overall clinical success rates for ERCP and EUS‐CDS were 94.1% (96/102) and 93.6% (72/78), respectively (p = 0.765). Further high‐quality evidence is needed to establish EUS‐CDS as a primary drainage technique.