Endoscopy 2022; 54(02): 185-205
DOI: 10.1055/a-1717-1391
Guideline

Therapeutic endoscopic ultrasound: European Society of Gastrointestinal Endoscopy (ESGE) Guideline

Schalk W. van der Merwe
 1   Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
,
 2   Department of Gastroenterology and Hepatology, Amsterdam UMC, Vrije Universiteit Amsterdam, AGEM Institute, Amsterdam, The Netherlands
,
 1   Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
 3   Department of Gastroenterology and Hepatology, Imelda General Hospital, Bonheiden, Belgium
,
Simon Everett
 4   Department of Gastroenterology and Hepatology, Leeds Teaching Hospital NHS Trust, Leeds, UK
,
Sundeep Lakhtakia
 5   Department of Medical Gastroenterology, Asian Institute of Gastroenterology Hospitals, Gachibowli, Hyderabad, India
,
 6   Gastroenterology Department, Colentina Clinical Hospital, Bucharest, Romania
,
Tomas Hucl
 7   Department of Gastroenterology and Hepatology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
,
 8   Department of Surgery, Department of Gastroenterology and Hepatology, and Department of Advanced Interventional Endoscopy, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
,
Abdenor Badaoui
 9   Department of Gastroenterology and Hepatology, Université catholique de Louvain, CHU UCL Namur, Yvoir, Belgium
,
Ryan Law
10   Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
,
Paolo G. Arcidiacono
11   Pancreatobiliary Endoscopy and Endosonography Division, IRCCS San Raffaele Scientific Institute, Milan, Italy
,
Alberto Larghi
12   Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, and Center for Endoscopic Research Therapeutics and Training (CERTT), Catholic University, Rome, Italy
,
Marc Giovannini
13   Paoli-Calmettes Institute, Department of Gastrointestinal Disease, Marseille, France
,
Mouen A. Khashab
14   Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland, USA
,
Kenneth F. Binmoeller
15   Interventional Endoscopy Services, California Pacific Medical Center, San Francisco, California, USA
,
16   Department of Gastroenterology, Aix-Marseille Université, APHM, Hôpital Nord, Marseille, France
,
17   Gastroenterology Department, Hospital Universitario Rio Hortega, Valladolid, Spain
,
18   Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, The Netherlands
› Author Affiliations

Main Recommendations

1 ESGE recommends the use of endoscopic ultrasound-guided biliary drainage (EUS-BD) over percutaneous transhepatic biliary drainage (PTBD) after failed endoscopic retrograde cholangiopancreatography (ERCP) in malignant distal biliary obstruction when local expertise is available.

Strong recommendation, moderate quality evidence.

2 ESGE suggests EUS-BD with hepaticogastrostomy only for malignant inoperable hilar biliary obstruction with a dilated left hepatic duct when inadequately drained by ERCP and/or PTBD in high volume expert centers.

Weak recommendation, moderate quality evidence.

3 ESGE recommends that EUS-guided pancreatic duct (PD) drainage should only be considered in symptomatic patients with an obstructed PD when retrograde endoscopic intervention fails or is not possible.

Strong recommendation, low quality evidence.

4 ESGE recommends rendezvous EUS techniques over transmural PD drainage in patients with favorable anatomy owing to its lower rate of adverse events.

Strong recommendation, low quality evidence.

5 ESGE recommends that, in patients at high surgical risk, EUS-guided gallbladder drainage (GBD) should be favored over percutaneous gallbladder drainage where both techniques are available, owing to the lower rates of adverse events and need for re-interventions in EUS-GBD.

Strong recommendation, high quality of evidence.

6 ESGE recommends EUS-guided gastroenterostomy (EUS-GE), in an expert setting, for malignant gastric outlet obstruction, as an alternative to enteral stenting or surgery.

Strong recommendation, low quality evidence.

7 ESGE recommends that EUS-GE may be considered in the management of afferent loop syndrome, especially in the setting of malignancy or in poor surgical candidates.

Strong recommendation, low quality evidence.

8 ESGE suggests that endoscopic ultrasound-directed transgastric ERCP (EDGE) can be offered, in expert centers, to patients with a Roux-en-Y gastric bypass following multidisciplinary decision-making, with the aim of overcoming the invasiveness of laparoscopy-assisted ERCP and the limitations of enteroscopy-assisted ERCP.

Weak recommendation, low quality evidence.

Supplementary material



Publication History

Article published online:
22 December 2021

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