Endoscopic ultrasonography (EUS)-guided access and therapy of pancreatico-biliary disorders: EUS-guided cholangio and pancreatic drainage.

Endoscopic ultrasonography (EUS)-guided cholangio pancreatic drainage (ECPD) has been reported as an alternative to surgery or percutaneous transhepatic cholangiography if endoscopic retrograde cholangiopancreatography (ERCP) is unsuccessful. With the development of EUS and the ability to direct a puncture within the field of vision, ECPD has been used increasingly in tertiary centers. 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, including our own data, 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. The techniques, efficacy, and complication of ECPD are discussed.