Faculty Bibliography

BACKGROUND:EUS-guided biliary drainage (EGBD) can be performed via direct transluminal or rendezvous techniques. It is unknown how both techniques compare in terms of efficacy and adverse events. OBJECTIVE:To describe outcomes of EGBD performed by using a standardized approach and compare outcomes of rendezvous and transluminal techniques. DESIGN/METHODS:Retrospective analysis of prospectively collected data. SETTING/METHODS:Two tertiary-care centers. PATIENTS/METHODS:Consecutive jaundiced patients with distal malignant biliary obstruction who underwent EGBD after failed ERCP between July 2006 and December 2012 were included. INTERVENTION/METHODS:EGBD by using a standardized algorithm. MAIN OUTCOME MEASUREMENTS/METHODS:Technical success, clinical success, and adverse events. RESULTS:During the study period, 35 patients underwent EGBD (rendezvous n = 13, transluminal n = 20). Technical success was achieved in 33 patients (94%), and clinical success was attained in 32 of 33 patients (97.0%). The mean postprocedure bilirubin level was 1.38 mg/dL in the rendezvous group and 1.33 mg/dL in the transluminal group (P = .88). Similarly, length of hospital stay was not different between groups (P = .23). There was no significant difference in adverse event rate between rendezvous and transluminal groups (15.4% vs 10%; P = .64). Long-term outcomes were comparable between groups, with 1 stent migration in the rendezvous group at 62 days and 1 stent occlusion in the transluminal group at 42 days after EGBD. LIMITATIONS/CONCLUSIONS:Retrospective analysis, small number of patients, and selection bias. CONCLUSION/CONCLUSIONS:EGBD is safe and effective when the described standardized approach is used. Stent occlusion is not common during long-term follow-up. Both rendezvous and direct transluminal techniques seem to be equally effective and safe. The latter approach is a reasonable alternative to rendezvous EGBD.

Over the last 2 decades there has been continuing development in endoscopic ultrasonography (EUS). EUS-guided pancreatic drainage is an evolving procedure that can be offered to patients who are high-risk surgical candidates and in whom the pancreatic duct cannot be accessed by endoscopic retrograde pancreatography. Although EUS-guided pancreatic drainage is a minimally invasive alternative option to surgery and interventional radiology, owing to its complexity and potential for fulminant complications it is recommended that these procedures be performed by highly skilled endoscopists. Additional data are needed to define risks and long-term outcomes more accurately via a dedicated prospective registry.

Pancreatic stenting for patients with obstructive pain secondary to a malignant pancreatic duct stricture is safe and effective, and should be considered a therapeutic option. Although pancreatic stenting does not seem to be effective for patients with chronic pain, it may be beneficial in those with obstructive type pains, pancreatic duct disruption, or smoldering pancreatitis. Fully covered metal stents may be an option, but data on their use are limited. Further studies, including prospective randomized studies comparing plastic and metal stents in these indications, are needed to further validate and confirm these results.

There are a variety of advanced gastrointestinal endoscopic procedures, many of which are guided by endosonography, which are performed by interventional gastroenterologists or minimally-invasive surgeons. The purpose of this pictorial review is to briefly describe several advanced gastrointestinal endoscopically guided procedures, to review the implications for radiologists interpreting the associated imaging examinations, and to demonstrate the expected preprocedural imaging findings, as well as the expected and the unexpected postprocedural findings, in patients undergoing these procedures.