Endoscopic Ultrasonography-Guided Drainage of the Biliary-Pancreatic Ductal Systems and Gallbladder

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.