Clinical Management of Bile Duct Diseases: Role of Endoscopic Ultrasound in a Personalized Approach
Abstract
:1. Introduction
2. Materials and Methods
2.1. Search for Literature
2.2. Available Echoendoscopes and Technique of EUS Examination of the Biliary System
3. Clinical Application and Performance of EUS in Biliary Diseases
3.1. Biliary Stone Disease
3.2. Evaluation of Indeterminate Biliary Strictures
- Local EUS-staging of CCC includes evaluation of the tumor growth pattern and involvement of local lymph nodes. EUS provides high accuracy in terms of local tumor staging of 66–81% and of local lymph node staging of 64–81% and 88–100% in prediction of portal vein infiltration [22]. Intraductal ultrasound seems to provide a high overall accuracy for the local T-staging of cholangiocarcinoma of 92%, whereas its accuracy for staging of lymph node involvement is low with 43% [4].
- The sensitivity and specificity of EUS-based tissue acquisition for the diagnosis of CCC in patients with indeterminate extrahepatic biliary strictures in two recent meta-analyses of 20 and 6 studies, were 66–80% and 97–100%, respectively [21,27]. Another meta-analysis of 10 studies illustrated that EUS was able to improve the detection rate of malignancies in those patients who were investigated for extrahepatic biliary strictures and received a primary non-malignant diagnosis in ERCP by 14% [28]. However, a proximal position of the stricture close to the hilum and indwell of biliary stents may impede the efficacy of EUS-TA in indeterminate extrahepatic biliary strictures. Where possible, EUS-TA should be accomplished directly before ERCP to improve diagnostic yield and staging accuracy in suspected biliary neoplasms. EUS-directed FNA is generally considered safe with low overall rates of adverse events and severe adverse events of 1% and 0.3% [21]. Some authors reported a risk of Needle-track seeding associated with EUS-FNA in hilar CCC whereas this may be of less relevance in distal biliary tumors, as the needle track within the duodenal wall following transmural EUS-FNA is entirely resected during pancreaticoduodenectomy [21].
3.3. Endoscopic Ultrasound Guided Biliary Drainage
3.3.1. Techniques of EUS-Guided Biliary Drainage (EUS-BD)
3.3.2. Efficacy and Safety of EUS-BD
- (a)
- Different techniques and routes to access the bile ducts, including hepatogastrostomy (EUS-HG), cholecystostomy, choledochoduodenostomy (EUS-CDD), and other techniques;
- (b)
- Use of different modalities of drainage, such as plastic stents, SEMS, LAMS, nasobiliary drainage tubes, and a combination of these;
- (c)
- The long learning curve with the use of EUS-BD with accumulating experience. A retrospective multicenter trial could show a higher success rate for EUS-BD procedures performed by endoscopists having done more than 500 procedures [40].
3.3.3. EUS-Guided Drainage of the Gallbladder
3.3.4. EUS-Guided Biliary Decompression Ready for Prime Time?
4. Discussion
5. Conclusions
Author Contributions
Funding
Conflicts of Interest
References
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Beyna, T.; Gerges, C. Clinical Management of Bile Duct Diseases: Role of Endoscopic Ultrasound in a Personalized Approach. J. Pers. Med. 2021, 11, 1. https://doi.org/10.3390/jpm11010001
Beyna T, Gerges C. Clinical Management of Bile Duct Diseases: Role of Endoscopic Ultrasound in a Personalized Approach. Journal of Personalized Medicine. 2021; 11(1):1. https://doi.org/10.3390/jpm11010001
Chicago/Turabian StyleBeyna, Torsten, and Christian Gerges. 2021. "Clinical Management of Bile Duct Diseases: Role of Endoscopic Ultrasound in a Personalized Approach" Journal of Personalized Medicine 11, no. 1: 1. https://doi.org/10.3390/jpm11010001