CC BY 4.0 · Journal of Digestive Endoscopy 2023; 14(02): 074-087
DOI: 10.1055/s-0043-1768043
Guidelines

Society of Gastrointestinal Endoscopy of India Consensus Guidelines on Endoscopic Ultrasound-Guided Biliary Drainage: Part II (Technical Aspects)

1   Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
,
Priyanka Udawat
2   School of EUS, Institute of Digestive and Liver Care, S. L. Raheja Hospital, Mumbai, Maharashtra, India
,
Sudipta Dhar Chowdhary
3   Department of Gastroenterology, Christian Medical College, Vellore, Tamil Nadu, India
,
4   Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi, India
,
5   Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute, Lucknow, Uttar Pradesh, India
,
Vikram Bhatia
6   Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India
,
7   Department of Gastroenterology, Max Super Speciality Hospital, New Delhi, India
,
Saurabh Mukewar
8   Department of Gastroenterology, Midas Hospital, Nagpur, Maharashtra, India
,
Nilay Mehta
9   Department of Gastroenterology, Zydus Hospital, Ahmedabad, Gujrat, India
,
10   Department of Gastroenterology, KIMS ICON Hospital, Vishakhapatnam, Andhra Pradesh, India
,
Ankit Dalal
11   Baldota Institute of Digestive Sciences, Global Hospital, Mumbai, Maharashtra, India
,
12   Institute of GI Sciences, Apollo Hospitals, Bhubaneshwar, Odisha, India
,
Avinash Balekuduru
13   Department of Gastroenterology, MS Ramaiah Medical college and Hospital, Bengaluru, Karnataka, India
,
14   Department of Medical Gastroenterology, Saptaghiri Institute of Medical Sciences, Bengaluru, Karnataka, India
,
Jahangir Basha
15   Asian Institute of Gastroenterology, AIG Hospitals, Hyderabad, Telangana, India
,
16   Department of Gastroenterology, Lisie Hospital, Kochi, Kerala, India
,
Surinder Rana
1   Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
,
Rajesh Puri
17   Institute of Digestive and Hepatobiliary Sciences, Medanta Hospital, Gurugram, Haryana, India
,
15   Asian Institute of Gastroenterology, AIG Hospitals, Hyderabad, Telangana, India
,
Vinay Dhir
2   School of EUS, Institute of Digestive and Liver Care, S. L. Raheja Hospital, Mumbai, Maharashtra, India
,
India EUS Club › Author Affiliations

Abstract

Endoscopic management of bile duct obstruction is a key aspect in gastroenterology practice and has evolved since the first description of biliary cannulation by McCune et al in 1968. Over many decades, the techniques and accessories have been refined, and currently, the first-line management for extrahepatic biliary obstruction is endoscopic retrograde cholangiopancreatography (ERCP). However, even in expert hands, the success rate of ERCP reaches up to 95%. In almost 4 to 16% cases, failure to cannulate the bile duct may necessitate other alternatives such as surgical bypass or, more commonly, percutaneous transhepatic biliary drainage (PTBD). While surgery is associated with high morbidity and mortality, PTBD has a very high reintervention and complication rate (∼80%) and poor quality of life. Almost parallelly, endoscopic ultrasound (EUS) has come a long way from a mere diagnostic tool to a substantial therapeutic option in various pancreaticobiliary diseases. Biliary drainage using EUS-guidance (EUS-BD) has gained momentum since the first report published by Giovannini et al in 2001. The concept of accessing the bile duct through a different route than the papilla, circumventing the shortcomings of PTBD, and sometimes bypassing the actual obstruction have enthused a lot of interest in this novel strategy. The three key methods of EUS-BD entail transluminal, antegrade, and rendezvous approach. Over the past decade, with growing experience, EUS-BD has been found to be equivalent to ERCP or PTBD for malignant obstruction with better success rates. EUS-BD, however, is not devoid of adverse events and can carry fatal adverse events. However, neither the technique of EUS-BD nor the accessories and stents for EUS-BD have been standardized. Additionally, different countries and regions have different availability of the accessories, making generalizability a difficult task. Thus, technical aspects of this evolving therapy need to be outlined. For these reasons, Society of Gastrointestinal Endoscopy of India (SGEI) deemed it appropriate to develop technical consensus statements for performing safe and successful EUS-BD.

Supplementary Material



Publication History

Article published online:
24 April 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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  • References

  • 1 McCune WS, Shorb PE, Moscovitz H. Endoscopic cannulation of the ampulla of vater: a preliminary report. Ann Surg 1968; 167 (05) 752-756
  • 2 Mukai S, Itoi T, Baron TH. et al. Indications and techniques of biliary drainage for acute cholangitis in updated Tokyo Guidelines 2018. J Hepatobiliary Pancreat Sci 2017; 24 (10) 537-549
  • 3 Holt BA, Hawes R, Hasan M. et al. Biliary drainage: role of EUS guidance. Gastrointest Endosc 2016; 83 (01) 160-165
  • 4 Hayat U, Bakker C, Dirweesh A. et al. EUS-guided versus percutaneous transhepatic cholangiography biliary drainage for obstructed distal malignant biliary strictures in patients who have failed endoscopic retrograde cholangiopancreatography: a systematic review and meta-analysis. Endosc Ultrasound 2022; 11 (01) 4-16
  • 5 Giovannini M, Moutardier V, Pesenti C, Bories E, Lelong B, Delpero JR. Endoscopic ultrasound-guided bilioduodenal anastomosis: a new technique for biliary drainage. Endoscopy 2001; 33 (10) 898-900
  • 6 Sharaiha RZ, Khan MA, Kamal F. et al. Efficacy and safety of EUS-guided biliary drainage in comparison with percutaneous biliary drainage when ERCP fails: a systematic review and meta-analysis. Gastrointest Endosc 2017; 85 (05) 904-914
  • 7 Paik WH, Lee TH, Park DH. et al. EUS-guided biliary drainage versus ERCP for the primary palliation of malignant biliary obstruction: a multicenter randomized clinical trial. Am J Gastroenterol 2018; 113 (07) 987-997
  • 8 Park JK, Woo YS, Noh DH. et al. Efficacy of EUS-guided and ERCP-guided biliary drainage for malignant biliary obstruction: prospective randomized controlled study. Gastrointest Endosc 2018; 88 (02) 277-282
  • 9 Guyatt G, Oxman AD, Akl EA. et al. GRADE guidelines: 1. Introduction-GRADE evidence profiles and summary of findings tables. J Clin Epidemiol 2011; 64 (04) 383-394
  • 10 Murad FM, Komanduri S, Abu Dayyeh BK. et al; ASGE Technology Committee. Echoendoscopes. Gastrointest Endosc 2015; 82 (02) 189-202
  • 11 Iwashita T, Nakai Y, Lee JG, Park DH, Muthusamy VR, Chang KJ. Newly-developed, forward-viewing echoendoscope: a comparative pilot study to the standard echoendoscope in the imaging of abdominal organs and feasibility of endoscopic ultrasound-guided interventions. J Gastroenterol Hepatol 2012; 27 (02) 362-367
  • 12 Fusaroli P, Ceroni L, Caletti G. Forward-view endoscopic ultrasound: a systematic review of diagnostic and therapeutic applications. Endosc Ultrasound 2013; 2 (02) 64-70
  • 13 Hara K, Yamao K, Hijioka S. et al. Prospective clinical study of endoscopic ultrasound-guided choledochoduodenostomy with direct metallic stent placement using a forward-viewing echoendoscope. Endoscopy 2013; 45 (05) 392-396
  • 14 Hara K, Okuno N, Haba S. et al. How to perform EUS-guided hepaticogastrostomy easier and safer. J Hepatobiliary Pancreat Sci 2020; 27 (08) 563-564
  • 15 Okuno N, Hara K, Mizuno N. et al. B2 puncture with forward-viewing EUS simplifies EUS-guided hepaticogastrostomy (with video). Endosc Ultrasound 2022; 11 (04) 319-324
  • 16 Kumbhari V, Peñas I, Tieu AH. et al. Interventional EUS using a flexible 19-gauge needle: an international multicenter experience in 162 patients. Dig Dis Sci 2016; 61 (12) 3552-3559
  • 17 Martínez B, Martínez J, Casellas JA, Aparicio JR. Endoscopic ultrasound-guided rendezvous in benign biliary or pancreatic disorders with a 22-gauge needle and a 0.018-inch guidewire. Endosc Int Open 2019; 7 (08) E1038-E1043
  • 18 Ogura T, Ueno S, Okuda A, Nishioka N, Higuchi K. EUS-guided hepaticogastrostomy for hepaticojejunostomy stricture using a 22G needle and a mechanical dilator (with video). J Hepatobiliary Pancreat Sci 2022; 29 (10) e88-e90
  • 19 Iwashita T, Ogura T, Ishiwatari H. et al. Utility of dedicated bougie dilator for a 0.018-inch guidewire during EUS-guided biliary drainage: a multi-center retrospective cohort study. J Hepatobiliary Pancreat Sci 2022; 29 (07) 810-816
  • 20 Ogura T, Ueno S, Okuda A. et al. Expanding indications for endoscopic ultrasound-guided hepaticogastrostomy for patients with insufficient dilatation of the intrahepatic bile duct using a 22G needle combined with a novel 0.018-inch guidewire (with video). Dig Endosc 2022; 34 (01) 222-227
  • 21 Ogura T, Okuda A, Ueno S. et al. Prospective comparison study between 19-gauge needle with .025-inch guidewire and 22-gauge needle with novel .018-inch guidewire during EUS-guided transhepatic biliary drainage (with video). Gastrointest Endosc 2022; 96 (02) 262-268.e1
  • 22 Dhir V, Kwek BE, Bhandari S, Bapat M, Maydeo A. EUS-guided biliary rendezvous using a short hydrophilic guidewire. J Interv Gastroenterol 2011; 1 (04) 153-159
  • 23 Dhir V, Bhandari S, Bapat M, Maydeo A. Comparison of EUS-guided rendezvous and precut papillotomy techniques for biliary access (with videos). Gastrointest Endosc 2012; 75 (02) 354-359
  • 24 Park DH, Jang JW, Lee SS, Seo DW, Lee SK, Kim MH. EUS-guided biliary drainage with transluminal stenting after failed ERCP: predictors of adverse events and long-term results. Gastrointest Endosc 2011; 74 (06) 1276-1284
  • 25 Khashab MA, Messallam AA, Penas I. et al. International multicenter comparative trial of transluminal EUS-guided biliary drainage via hepatogastrostomy vs. choledochoduodenostomy approaches. Endosc Int Open 2016; 4 (02) E175-E181
  • 26 Honjo M, Itoi T, Tsuchiya T. et al. Safety and efficacy of ultra-tapered mechanical dilator for EUS-guided hepaticogastrostomy and pancreatic duct drainage compared with electrocautery dilator (with video). Endosc Ultrasound 2018; 7 (06) 376-382
  • 27 Kitamura K, Yamamiya A, Ishii Y, Nomoto T, Honma T, Yoshida H. Electrocautery vs non-electrocautery dilation catheters in endoscopic ultrasonography-guided pancreatic fluid collection drainage. World J Gastrointest Endosc 2016; 8 (13) 458-465
  • 28 Uemura RS, Khan MA, Otoch JP, Kahaleh M, Montero EF, Artifon ELA. EUS-guided choledochoduodenostomy versus hepaticogastrostomy: a systematic review and meta-analysis. J Clin Gastroenterol 2018; 52 (02) 123-130
  • 29 Ogura T, Itoi T. Technical tips and recent development of endoscopic ultrasound-guided choledochoduodenostomy. DEN Open 2021; 1 (01) e8
  • 30 Ryou M, Benias PC, Kumbhari V. Initial clinical experience of a steerable access device for EUS-guided biliary drainage. Gastrointest Endosc 2020; 91 (01) 178-184
  • 31 Ogura T, Higuchi K. Technical tips of endoscopic ultrasound-guided choledochoduodenostomy. World J Gastroenterol 2015; 21 (03) 820-828
  • 32 Ogura T, Masuda D, Takeuchi T, Fukunishi S, Higuchi K. Intraluminal water filling technique to prevent double mucosal puncture during EUS-guided choledochoduodenostomy. Gastrointest Endosc 2016; 83 (04) 834-835
  • 33 Matsumoto S, Hara K, Mizuno N. et al. Risk factor analysis for adverse events and stent dysfunction of endoscopic ultrasound-guided choledochoduodenostomy. Dig Endosc 2020; 32 (06) 957-966
  • 34 Cho DH, Lee SS, Oh D. et al. Long-term outcomes of a newly developed hybrid metal stent for EUS-guided biliary drainage (with videos). Gastrointest Endosc 2017; 85 (05) 1067-1075
  • 35 Ogura T, Nishioka N, Yamada M, Yamada T, Higuchi K. Comparison study between double bare covered and fully covered metal stent during endoscopic ultrasound-guided choledochoduodenostomy (with video). Dig Dis 2021; 39 (02) 165-170
  • 36 Binmoeller KF, Shah J. A novel lumen-apposing stent for transluminal drainage of nonadherent extraintestinal fluid collections. Endoscopy 2011; 43 (04) 337-342
  • 37 Anderloni A, Fugazza A, Troncone E. et al. Single-stage EUS-guided choledochoduodenostomy using a lumen-apposing metal stent for malignant distal biliary obstruction. Gastrointest Endosc 2019; 89 (01) 69-76
  • 38 Jacques J, Privat J, Pinard F. et al. EUS-guided choledochoduodenostomy by use of electrocautery-enhanced lumen-apposing metal stents: a French multicenter study after implementation of the technique (with video). Gastrointest Endosc 2020; 92 (01) 134-141
  • 39 Krishnamoorthi R, Dasari CS, Thoguluva Chandrasekar V. et al. Effectiveness and safety of EUS-guided choledochoduodenostomy using lumen-apposing metal stents (LAMS): a systematic review and meta-analysis. Surg Endosc 2020; 34 (07) 2866-2877
  • 40 Amato A, Sinagra E, Celsa C. et al. Efficacy of lumen-apposing metal stents or self-expandable metal stents for endoscopic ultrasound-guided choledochoduodenostomy: a systematic review and meta-analysis. Endoscopy 2021; 53 (10) 1037-1047
  • 41 El Chafic AH, Shah JN, Hamerski C. et al. EUS-guided choledochoduodenostomy for distal malignant biliary obstruction using electrocautery-enhanced lumen-apposing metal stents: first US, multicenter experience. Dig Dis Sci 2019; 64 (11) 3321-3327
  • 42 de Benito Sanz M, Nájera-Muñoz R, de la Serna-Higuera C. et al. Lumen apposing metal stents versus tubular self-expandable metal stents for endoscopic ultrasound-guided choledochoduodenostomy in malignant biliary obstruction. Surg Endosc 2021; 35 (12) 6754-6762
  • 43 Garcia-Sumalla A, Loras C, Guarner-Argente C. et al. Is a coaxial plastic stent within a lumen-apposing metal stent useful for the management of distal malignant biliary obstruction?. Surg Endosc 2021; 35 (08) 4873-4881
  • 44 Garcia-Sumalla A, Loras C, Sanchiz V. et al; Spanish Working Group on Endoscopic Ultrasound Guided Biliary Drainage. Multicenter study of lumen-apposing metal stents with or without pigtail in endoscopic ultrasound-guided biliary drainage for malignant obstruction-BAMPI TRIAL: an open-label, randomized controlled trial protocol. Trials 2022; 23 (01) 181
  • 45 Miyano A, Ogura T, Yamamoto K, Okuda A, Nishioka N, Higuchi K. Clinical impact of the intra-scope channel stent release technique in preventing stent migration during EUS-guided hepaticogastrostomy. J Gastrointest Surg 2018; 22 (07) 1312-1318
  • 46 Burmester E, Niehaus J, Leineweber T, Huetteroth T. EUS-cholangio-drainage of the bile duct: report of 4 cases. Gastrointest Endosc 2003; 57 (02) 246-251
  • 47 Li J, Tang J, Liu F, Fang J. Comparison of choledochoduodenostomy and hepaticogastrostomy for EUS-guided biliary drainage: a meta-analysis. Front Surg 2022; 9: 811005
  • 48 Okuno N, Hara K, Mizuno N. et al. Risks of transesophageal endoscopic ultrasonography-guided biliary drainage. Int J Gastrointest Interv 2017; 6: 82-84
  • 49 Ogura T, Higuchi K. Endoscopic ultrasound-guided hepaticogastrostomy: technical review and tips to prevent adverse events. Gut Liver 2021; 15 (02) 196-205
  • 50 Ogura T, Nishioka N, Ueno S. et al. Effect of echoendoscope angle on success of guidewire manipulation during endoscopic ultrasound-guided hepaticogastrostomy. Endoscopy 2021; 53 (04) 369-375
  • 51 Ogura T, Masuda D, Takeuchi T, Fukunishi S, Higuchi K. Liver impaction technique to prevent shearing of the guidewire during endoscopic ultrasound-guided hepaticogastrostomy. Endoscopy 2015; 47 (S 01): E583-E584
  • 52 Ueno S, Ogura T, Higuchi K. Moving scope technique for guidewire insertion during endoscopic ultrasound-guided hepaticogastrostomy. Dig Endosc 2021; 33 (05) e109-e110
  • 53 Ogura T, Ueno S, Okuda A, Nishioka N, Higuchi K. Jumping technique for guidewire manipulation within an intrahepatic bile duct during EUS-guided biliary drainage (with video). Endosc Ultrasound 2021; 10 (04) 305-306
  • 54 Nishiguchi K, Ogura T, Nishioka N. et al. Clinical evaluation of physician-controlled guidewire manipulation during endoscopic ultrasound-guided hepaticogastrostomy (with video). Endosc Int Open 2021; 9 (03) E395-E400
  • 55 Oh D, Park DH, Song TJ. et al. Optimal biliary access point and learning curve for endoscopic ultrasound-guided hepaticogastrostomy with transmural stenting. Therap Adv Gastroenterol 2017; 10 (01) 42-53
  • 56 Yamamoto Y, Ogura T, Nishioka N. et al. Risk factors for adverse events associated with bile leak during EUS-guided hepaticogastrostomy. Endosc Ultrasound 2020; 9 (02) 110-115
  • 57 Ishiwatari H, Satoh T, Sato J. et al. Bile aspiration during EUS-guided hepaticogastrostomy is associated with lower risk of postprocedural adverse events: a retrospective single-center study. Surg Endosc 2021; 35 (12) 6836-6845
  • 58 Park DH, Lee TH, Paik WH. et al. Feasibility and safety of a novel dedicated device for one-step EUS-guided biliary drainage: a randomized trial. J Gastroenterol Hepatol 2015; 30 (10) 1461-1466
  • 59 Umeda J, Itoi T, Tsuchiya T. et al. A newly designed plastic stent for EUS-guided hepaticogastrostomy: a prospective preliminary feasibility study (with videos). Gastrointest Endosc 2015; 82 (02) 390-396.e2
  • 60 Nakai Y, Isayama H, Yamamoto N. et al. Safety and effectiveness of a long, partially covered metal stent for endoscopic ultrasound-guided hepaticogastrostomy in patients with malignant biliary obstruction. Endoscopy 2016; 48 (12) 1125-1128
  • 61 Yang MJ, Kim JH, Kim DJ, Hwang JC, Yoo BM. Hepatobiliary and pancreatic: EUS-guided reintervention for extraluminal stent migration after EUS-guided hepaticogastrostomy. J Gastroenterol Hepatol 2018; 33 (04) 772-772
  • 62 Ogura T, Yamamoto K, Sano T. et al. Stent length is impact factor associated with stent patency in endoscopic ultrasound-guided hepaticogastrostomy. J Gastroenterol Hepatol 2015; 30 (12) 1748-1752
  • 63 Uchida D, Kawamoto H, Kato H. et al. The intra-conduit release method is useful for avoiding migration of metallic stents during EUS-guided hepaticogastrostomy (with video). J Med Ultrason 2018; 45 (03) 399-403
  • 64 Nguyen-Tang T, Binmoeller KF, Sanchez-Yague A, Shah JN. Endoscopic ultrasound (EUS)-guided transhepatic anterograde self-expandable metal stent (SEMS) placement across malignant biliary obstruction. Endoscopy 2010; 42 (03) 232-236
  • 65 Iwashita T, Doi S, Yasuda I. Endoscopic ultrasound-guided biliary drainage: a review. Clin J Gastroenterol 2014; 7 (02) 94-102
  • 66 Mukai S, Itoi T. EUS-guided antegrade procedures. Endosc Ultrasound 2019; 8 (Suppl. 01) S7-S13
  • 67 Iwashita T, Uemura S, Tezuka R. et al. Current status of endoscopic ultrasound-guided antegrade intervention for biliary diseases in patients with surgically altered anatomy. Dig Endosc 2022
  • 68 Almadi MA, Barkun AN, Martel M. No benefit of covered vs uncovered self-expandable metal stents in patients with malignant distal biliary obstruction: a meta-analysis. Clin Gastroenterol Hepatol 2013; 11 (01) 27-37.e1
  • 69 Iwashita T, Yasuda I, Mukai T. et al. Endoscopic ultrasound-guided antegrade biliary stenting for unresectable malignant biliary obstruction in patients with surgically altered anatomy: single-center prospective pilot study. Dig Endosc 2017; 29 (03) 362-368
  • 70 Ogura T, Kitano M, Takenaka M. et al. Multicenter prospective evaluation study of endoscopic ultrasound-guided hepaticogastrostomy combined with antegrade stenting (with video). Dig Endosc 2018; 30 (02) 252-259
  • 71 So H, Oh D, Takenaka M. et al. Initial experience of endoscopic ultrasound-guided antegrade covered stent placement with long duodenal extension for malignant distal biliary obstruction (with video). J Hepatobiliary Pancreat Sci 2021; 28 (12) 1130-1137
  • 72 Klair JS, Zafar Y, Ashat M. et al. Effectiveness and safety of EUS rendezvous after failed biliary cannulation with ERCP: a systematic review and proportion meta-analysis. J Clin Gastroenterol 2023; 57 (02) 211-217
  • 73 Dhir V, Bhandari S, Bapat M, Joshi N, Vivekanandarajah S, Maydeo A. Comparison of transhepatic and extrahepatic routes for EUS-guided rendezvous procedure for distal CBD obstruction. United European Gastroenterol J 2013; 1 (02) 103-108
  • 74 Iwashita T, Lee JG, Shinoura S. et al. Endoscopic ultrasound-guided rendezvous for biliary access after failed cannulation. Endoscopy 2012; 44 (01) 60-65
  • 75 Park DH, Jeong SU, Lee BU. et al. Prospective evaluation of a treatment algorithm with enhanced guidewire manipulation protocol for EUS-guided biliary drainage after failed ERCP (with video). Gastrointest Endosc 2013; 78 (01) 91-101
  • 76 Okuno N, Hara K, Mizuno N. et al. Endoscopic ultrasound-guided rendezvous technique after failed endoscopic retrograde cholangiopancreatography: which approach route is the best?. Intern Med 2017; 56 (23) 3135-3143
  • 77 Dhir V, Artifon EL, Gupta K. et al. Multicenter study on endoscopic ultrasound-guided expandable biliary metal stent placement: choice of access route, direction of stent insertion, and drainage route. Dig Endosc 2014; 26 (03) 430-435
  • 78 Iwashita T, Yasuda I, Mukai T. et al. EUS-guided rendezvous for difficult biliary cannulation using a standardized algorithm: a multicenter prospective pilot study (with videos). Gastrointest Endosc 2016; 83 (02) 394-400
  • 79 Dhir V. Top tips for EUS-guided biliary rendezvous (with video). Gastrointest Endosc 2022; 96 (05) 857-860
  • 80 Tang Z, Igbinomwanhia E, Elhanafi S, Othman MO. Endoscopic ultrasound guided rendezvous drainage of biliary obstruction using a new flexible 19-gauge fine needle aspiration needle. Diagn Ther Endosc 2016; 2016: 3125962
  • 81 Matsubara S, Nakagawa K, Suda K. et al. A proposed algorithm for endoscopic ultrasound-guided rendezvous technique in failed biliary cannulation. J Clin Med 2020; 9 (12) 9
  • 82 Nakai Y, Isayama H, Matsubara S. et al. A novel “hitch-and-ride” deep biliary cannulation method during rendezvous endoscopic ultrasound-guided ERCP technique. Endoscopy 2017; 49 (10) 983-988