EUS Guided Drainage and Access for Malignant Biliary Strictures

Endoscopic stenting for biliary drainage through ERCP is the mainstay of endoscopic palliation for malignant biliary obstruction. Endoscopic ultrasound (EUS)-guided transenteric drainage has expanded to the drainage of biliary trees, including the gallbladder (GB). EUS guided biliary drainage (EUS-BD) can be performed during the same endoscopy trial for the failed or impossible cases with ERCP guided conventional drainage in selected cases. Conventional stents have a chance of migration or leakage that can lead to serious complications. A fully covered self-expandable metal stent designed as a lumen-apposing stent (LAMS) has been developed to minimize these complications and to improve efficacy. It can be used for EUS-guided choledochoduodenostomy, or GB drainage for the effective drainage for malignant biliary strictures. EUS-BD using a LAMS has rendered endoscopic bile duct or gallbladder assessment through a stent. Some therapeutic interventions using by ultra-slim endoscope can be performed through LAMS. From our study results, multibending ultra-slim endoscope can be effectively and safely performed through a LAMS after EUS-BD. In conclusion, EUS-BD related procedures can be expanded by continuous evolution of dedicated scopes, accessories, and devices including specialized stents.