Medium-long term outcomes of EUS-guided choledochoduodenostomy

Endoscopic ultrasound-guided biliary drainage (EUS-BD) has traditionally been considered a rescue therapy after unsuccessful Endoscopic Retrograde Cholangiopancreatography (ERCP). Current guidelines recommend that EUS-BD for primary drainage can be considered in the case of malignant distal biliary obstruction (MDBO) in inoperable patients. EUS-guided choledochoduodenostomy (EUS-CDS) is among the preferred strategies in this setting because of the high technical and clinical success rate associated with a good safety profile. Although there is still scarce evidence to recommend its use in resectable patients, EUS-CDS appears to be associated with a low rate of post-procedural and post-surgical complications without compromising oncological and post-surgical outcomes. Despite the high clinical and technical success rates, along with the development of modern devices that have facilitated the widespread use of this technique, some concerns regarding long-term outcomes have emerged, such as the risks related to stent dysfunction and the need for reintervention. This study aims to systematically and critically review the technical aspects of EUS-CDS, including an analysis of the short and long term outcomes; it also aims to identify potential strategies to improve patient outcomes.