Gastrointest Interv.  2017 Jul;6(2):114-117. 10.18528/gii.160012.

Endoscopic ultrasound-guided biliary drainage: Complications and their management

Affiliations
  • 1Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan. isayama-tky@umin.ac.jp
  • 2Department of Gastroenterology, Japanese Red Cross Medical Center, Tokyo, Japan.

Abstract

Endoscopic ultrasound-guided biliary drainage (EUS-BD), EUS-guided choledochoduodenostomy (EUS-CDS), and EUS-guided hepaticogastrostomy (EUS-HGS) can effectively palliate obstructive jaundice, but have not been well established yet. The incidence of complications is about 30% in EUSBD and higher for EUS-HGS. Several complications have been reported such as bleeding, perforation and peritonitis. Bleeding occurs due to puncture of portal vein, hepatic vein and artery, and we should use color Doppler. When a cautery dilator is used for fistula dilation, burn effects may cause delayed bleeding. Endoscopic hemostasis is only effective for anastomotic bleeding and embolization with interventional radiology technique is required for pseudo aneurysm. There are some types of perforation: failed stent placement after puncture or fistula dilation, double puncture during CDS procedure, and stent migration. Peritonitis with perforation requires surgery and can be fatal. Stent migration before mature fistula formation causes severe peritonitis because EUS-BD makes fistula between two unattached organs. Stents with flaps or long covered self-expandable metallic stents (cSEMSs) are effective to prevent migration. Recent development of lumen apposing stents may reduce early migration in EUS-CDS. Peritonitis without migration can be due to 1) leakage of bile juice or gastric/duodenal contents during EUS-BD or 2) leakage along the placed stent. We should make procedure time as short as possible, and cSEMSs reduce bile leak along the stent by occluding the dilated fistula. In summary, we should understand the mechanism of complications and the technique to prevent and manage complications. Development of dedicated devices to increase the success rate and reduce complications is required.

Keyword

Biliary drainage; Biliary stricture; Endoscopic ultrasound; Endoscopic ultrasound-guided biliary drainage; Endoscopic ultrasound-guided intervention

MeSH Terms

Aneurysm
Arteries
Bile
Burns
Cautery
Choledochostomy
Drainage*
Fistula
Hemorrhage
Hemostasis, Endoscopic
Hepatic Veins
Incidence
Jaundice, Obstructive
Peritonitis
Portal Vein
Punctures
Radiology, Interventional
Stents
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