EUS‐Guided Drainage in the Pancreatobiliary Disease

Endoscopic ultrasound (EUS) was developed as a diagnostic modality but rapidly gained a role for a variety of therapeutic applications. Endoscopic ultrasonography (EUS)‐guided cholangio pancreatic drainage has been reported as an alternative to surgery or percutaneous transhepatic cholangiography if endoscopic retrograde cholangiopancreatography (ERCP) is unsuccessful. Its concept includes EUS‐guided access into a dilated biliary tree or main pancreatic duct, creation of a transenteric fistula deployment of a stent across the fistula or the ampulla after a rendezvous‐type procedure. EUS‐guided cholangio‐drainage may be performed in a transhepatic or extrahepatic fashion, whereas EUS‐ guided pancreatic drainage can be antegrade or retrograde. Their respective efficacy can be measured by resolution of biliary obstruction or pain improvement in case of pancreatic drainage. The current literature shows that ECPD has an acceptable success and complication rate and might be considered as first‐line therapy in centers offering expertise in EUS and ERCP.