TY - JOUR
T1 - Endoscopic ultrasound-guided biliary drainage and gastrointestinal anastomoses
T2 - the journey from promising innovations to standard of care
AU - Vanella, Giuseppe
AU - Dell’anna, Giuseppe
AU - Bronswijk, Michiel
AU - van Wanrooij, Roy L. J.
AU - Rizzatti, Gianenrico
AU - Gkolfakis, Paraskevas
AU - Larghi, Alberto
AU - van der Merwe, Schalk
AU - Arcidiacono, Paolo Giorgio
N1 - Funding Information: aPancreatobiliary Endoscopy and Endosonography Division, IRCCS San Raffaele Scientific Institute and University, Milan, Italy (Giuseppe Vanella, Giuseppe Dell’Anna, Paolo Giorgio Arcidiacono); bDepartment of Gastroenterology and Hepatology, University Hospitals Gasthuisberg, University of Leuven, Leuven, Belgium (Michiel Bronswijk, Schalk van der Merwe); cDepartment of Gastroenterology and Hepatology, Imelda General Hospital, Bonheiden, Belgium (Michiel Bronswijk); dDepartment of Gastroenterology and Hepatology, Amsterdam UMC, Vrije Universiteit, Amsterdam Gastroenterology Endocrinology & Metabolism, Amsterdam, The Netherlands (Roy L.J. van Wanrooij); eDigestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, and Center for Endoscopic Research Therapeutics and Training, Catholic University, Rome, Italy (Gianenrico Rizzatti, Alberto Larghi); fDepartment of Gastroenterology, Hepatopancreatology and Digestive Oncology, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium (Paraskevas Gkolfakis) Conflict of Interest: MB has consultancy agreements with Taewoong and Prion Medical and reports travel grants from Taewoong, Norgine and Prion Medical. RV reports consultancy agreement and research grant Boston-Scientific. AL has received consultancy fees from Boston Scientific and Pentax Medical, and educational fees from Taewoong Medical and receives research support from Medtronic. SvdM: co-chairs the Boston-Scientific Chair in Therapeutic Biliopancreatic Endoscopy, holds the Cook Medical chair in Portal Hypertension and holds consultancy agreements with Boston Scientific, Cook Medical and Pentax. All other Authors disclose no COI relevant for this article Publisher Copyright: © 2022 Hellenic Society of Gastroenterology.
PY - 2022/8/31
Y1 - 2022/8/31
N2 - Biliary obstruction (BO) and gastric outlet obstruction (GOO) are frequent complications of pancreatobiliary and gastroduodenal neoplasia, which can severely impact oncological outcomes, patient survival and quality of life. Although endoscopic retrograde cholangiopancreatography (ERCP) remains the gold standard for biliary drainage, this may fail or be unfeasible because of duodenal/papillary infiltration or surgically-altered anatomy. Percutaneous transhepatic biliary drainage (PTBD) has been the standard rescue therapy in this setting, but is burdened by high morbidity and reduced quality of life. As for GOO, surgical gastroenterostomy and enteral stenting are limited by invasiveness and suboptimal long-term outcomes, respectively. Endoscopic ultrasound (EUS) has evolved from a diagnostic to a therapeutic modality, providing a safe and effective alternative for draining the pancreatobiliary tract into the stomach or duodenum. EUS-guided biliary drainage (EUS-BD) has already demonstrated similar efficacy, greater safety and fewer reinterventions compared to PTBD, and can be performed in the same session after ERCP failure. Further development of lumen apposing metal stents has paved the way towards the creation of EUS-guided anastomoses. EUS-guided gastroenterostomy (EUS-GE) is nowadays increasingly used to treat GOO, combining the minimal invasiveness of endoscopy with surgical-range efficacy. This review summarizes the technical details, current evidence and society recommendations contributing to EUS-BD and EUS-GE gaining ground in everyday practice or tertiary referral centers and becoming crucial in improving the multidisciplinary management of cancer-related symptoms.
AB - Biliary obstruction (BO) and gastric outlet obstruction (GOO) are frequent complications of pancreatobiliary and gastroduodenal neoplasia, which can severely impact oncological outcomes, patient survival and quality of life. Although endoscopic retrograde cholangiopancreatography (ERCP) remains the gold standard for biliary drainage, this may fail or be unfeasible because of duodenal/papillary infiltration or surgically-altered anatomy. Percutaneous transhepatic biliary drainage (PTBD) has been the standard rescue therapy in this setting, but is burdened by high morbidity and reduced quality of life. As for GOO, surgical gastroenterostomy and enteral stenting are limited by invasiveness and suboptimal long-term outcomes, respectively. Endoscopic ultrasound (EUS) has evolved from a diagnostic to a therapeutic modality, providing a safe and effective alternative for draining the pancreatobiliary tract into the stomach or duodenum. EUS-guided biliary drainage (EUS-BD) has already demonstrated similar efficacy, greater safety and fewer reinterventions compared to PTBD, and can be performed in the same session after ERCP failure. Further development of lumen apposing metal stents has paved the way towards the creation of EUS-guided anastomoses. EUS-guided gastroenterostomy (EUS-GE) is nowadays increasingly used to treat GOO, combining the minimal invasiveness of endoscopy with surgical-range efficacy. This review summarizes the technical details, current evidence and society recommendations contributing to EUS-BD and EUS-GE gaining ground in everyday practice or tertiary referral centers and becoming crucial in improving the multidisciplinary management of cancer-related symptoms.
KW - Endoscopic ultrasound
KW - choledochoduodenostomy
KW - gastric outlet obstruction
KW - gastroenterostomy
KW - hepaticogastrostomy
UR - http://www.scopus.com/inward/record.url?scp=85137457295&partnerID=8YFLogxK
U2 - https://doi.org/10.20524/aog.2022.0736
DO - https://doi.org/10.20524/aog.2022.0736
M3 - Review article
C2 - 36061163
SN - 1108-7471
VL - 35
SP - 441
EP - 451
JO - Annals of Gastroenterology
JF - Annals of Gastroenterology
IS - 5
ER -