EUS-Guided Cholangio Drainage and Rendezvous Techniques

Percutaneous transhepatic cholangiography (PTC) has been classically used in cases of biliary obstruction where endoscopic retrograde cholangiopancreatography (ERCP) is unsuccessful. However, the complications of PTC are significant and include cholangitis, peritonitis, empyema, fistula, hematoma, and liver abscesses. With the development of endoscopic ultrasonography (EUS) and the ability to direct the needle within the field of intervention, EUS-guided cholangio drainage (ECD) is increasingly being used in tertiary care centers as an alternative to PTC. The studies that have been published thus far indicate that ECD has acceptable success and complication rates, such that it could be considered as a first-line therapy in centers offering expertise in EUS and ERCP. EUS-guided drainage may be either transhepatic or extrahepatic, depending on the most easily accessible region for drainage. Intrahepatic access to the biliary system appears safer than the extrahepatic approach. This review discusses the techniques, efficacy, and complications of ECD.