Original article

Clinical endoscopy: Editorial

EUS-guided pancreatic duct drainage: ready for prime time?

Endoscopic retrograde cholangiopancreatography (ERCP) is currently the standard for achieving endoscopic biliary and pancreatic duct drainage and high cannulation rates obtainable. However, in patients with failed ERCP, biliary drainage could be achieved by percutaneous or surgical means, while pancreatic duct drainage could only be achieved by surgery. Percutaneous biliary drainage is often less preferred by patients as the external drainage tube causes inconvenience and tube-related problems. Surgical biliary drainage is associated with lower rates of recurrent biliary obstruction, but the invasive nature of the procedure causes more adverse events resulting in longer hospital stay. On the other hand, in patients suffering from acute cholecystitis and at high-risk for cholecystectomy, percutaneous drainage is often used as a temporizing or definitive measure for gallbladder drainage. Similarly, the presence of an external tube is often less preferable to the patient and it does not allow treatment of the underlying gallstone.

As a result, EUS-guided biliary, pancreatic, and gallbladder drainage procedures are gaining popularity as alternatives to percutaneous or surgical drainages of the respective organs. These procedures offer the option of internal drainage without the need of an external tube with potentially lower risk of adverse events. This chapter will provide an overview on the various approaches, techniques and accessories, advantages and disadvantages, the reported outcomes as well as adverse events of these techniques.

Endoscopic ultrasound (EUS)–guided access to the biliary tree and pancreatic duct with concomitant therapeutic drainage of the ducts via the EUS scope is an evolving technology but being increasingly used by endosonographers. This article will explain the indications and techniques of how the procedure is performed in both the bile and pancreatic duct with a description of the equipment used. Finally, the technical and clinical success of EUS-guided ductal therapy and complications will be reviewed.