Current issues regarding endosonography-guided biliary drainage for biliary obstruction

Abstract

Transpapillary endoscopic biliary drainage is a well-accepted technique for patients with biliary obstruction. However, transpapillary access to the bile duct is not always possible, especially in patients with duodenal stenosis or difficult cannulation of the bile duct during endoscopic retrograde cholangiopancreatography. Percutaneous transhepatic biliary drainage or surgical bypass has been performed in cases of unsuccessful endoscopic retrograde cholangiopancreatography. Recently, endosonography-guided biliary drainage (ESBD) has been developed as a new biliary drainage technique. Current issues regarding ESBD are discussed in this article. Proper indications for ESBD should be established for widespread performance. Technical standardization and dedicated instruments for ESBD are also mandatory. © 2010 Japan Gastroenterological Endoscopy Society.