Article open access publication

A multi-institution consensus on how to perform EUS-guided biliary drainage for malignant biliary obstruction

Endoscopic Ultrasound, Wolters Kluwer, ISSN 2226-7190

Volume 7, 6, 2018

DOI:10.4103/eus.eus_53_18, Dimensions: pub.1110444132, PMC: PMC6289007, PMID: 30531022,



  1. (1) Sheng Jing Hospital, grid.412467.2
  2. (2) Institute Paoli-Calmettes, grid.418443.e
  3. (3) Center Hospitalier de l'Université de Montréal, Montreal, Canada.
  4. (4) Department of Endoscopy, University of Medicine and Pharmacy, Craiova, Romania.
  5. (5) Medical Department II, Caritas Hospital, Bad Mergentheim, Germany.
  6. (6) Tel Aviv Sourasky Medical Center, grid.413449.f
  7. (7) University of Bologna, grid.6292.f
  8. (8) Thomas Jefferson University Hospital, grid.412726.4
  9. (9) The University of Texas MD Anderson Cancer Center, grid.240145.6
  10. (10) Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong.
  11. (11) Dokkyo Medical University, grid.255137.7
  12. (12) University of Caldas, grid.7779.e
  13. (13) Gastroenterologist at Queen's NRI Hospital, Visakhapatnam, Andhra Pradesh, India.
  14. (14) Krankenhaus Märkisch-Oderland, grid.491912.6
  15. (15) University of Ulsan, grid.267370.7
  16. (16) University of Utah, grid.223827.e
  17. (17) Herlev Hospital, grid.411900.d, Capital Region
  18. (18) University of Sao Paulo, grid.11899.38
  19. (19) Department of Gastroenterology and Hepatology, Tokyo Adventist Hospital, Tokyo, Japan.
  20. (20) Erasmus University Medical Center, grid.5645.2
  21. (21) Wake Forest Baptist Medical Center, grid.412860.9
  22. (22) National University of Singapore, grid.4280.e
  23. (23) National Taiwan University Hospital, grid.412094.a
  24. (24) Cairo University, grid.7776.1
  25. (25) Rambam Health Care Campus, grid.413731.3
  26. (26) Complejo Hospitalario de Navarra, grid.497559.3
  27. (27) Complejo Hospitalario Universitario de Santiago, grid.411048.8
  28. (28) Aichi Cancer Center, grid.410800.d
  29. (29) Japanese Red Cross Society Kyoto Daini Hospital, grid.415627.3
  30. (30) Yokohama City University, grid.268441.d
  31. (31) Trocadero Clinic, Paris, France.
  32. (32) Clinica Reina Sofia, Bogota, Colombia.
  33. (33) Jaswant Rai Speciality Hospital, grid.414952.f
  34. (34) Kitasato University East Hospital, grid.482763.c
  35. (35) Royal Adelaide Hospital, grid.416075.1
  36. (36) All India Institute of Medical Sciences, grid.413618.9
  37. (37) Sanjay Gandhi Post Graduate Institute of Medical Sciences, grid.263138.d
  38. (38) Tokyo Medical University, grid.410793.8
  39. (39) Humanitas Research Hospital, grid.417728.f
  40. (40) Texas Tech University Health Sciences Center, grid.416992.1
  41. (41) Augusta University, grid.410427.4
  42. (42) Asian Institute of Gastroenterology, grid.410866.d
  43. (43) Post Graduate Institute of Medical Education and Research, grid.415131.3
  44. (44) Osaka Medical College, grid.444883.7
  45. (45) University of North Carolina at Chapel Hill, grid.10698.36
  46. (46) S.L. Raheja Hospital, grid.477921.e


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.

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