Post written by Ishaan Vohra, MD, from the Division of Gastroenterology, Hepatology and Nutrition, University of Illinois College of Medicine at Peoria, Peoria, Illinois, USA.

This study is a systematic review and meta-analysis to determine the number of procedures required to achieve proficiency in EUS-guided biliary drainage (EUS-BD). In addition, we assessed the clinical and technical success rates of EUS-BD and evaluated associated adverse events. 

EUS-BD is a safe, efficacious, and first-line treatment in distal malignant biliary obstruction with a high probability of failed ERCP. Beyond diagnostic EUS, in the hand of experienced endosonographers, the modality can be used for performing a variety of interventions and therapeutic maneuvers.

One EUS intervention of great interest is EUS-BD. Data on attaining proficiency for EUS-BD are disparate. It was essential to define the operator learning curve for EUS-BD, especially as advanced endoscopy carves its place in minimally invasive techniques. This study will help standardize training programs and procedural expectations for trainees and experienced gastroenterologists.

The study is a pooled analysis of 261 patients who underwent EUS-BD. Based on the pooled data, proficiency in EUS-BD is attained after 35 procedures, with a notable decrease in adverse events observed after 66 cases. The mean procedure time after achieving proficiency is 68.07 minutes. Technical success is reached in 92.45% of cases and clinical success in 84.84%.

To ensure patient safety, we recommend a minimum of 60 supervised procedures before independent practice, enhancing procedural safety and proficiency.

Notably, most procedures in this study were hepatogastrostomy or guidewire-directed choledochoduodenostomy. Future research studies focusing on lumen-apposing metal stent choledochoduodenostomy could yield significantly different results.

A, Forest plot showing the technical success rate of EUS-guided biliary drainage in the management of biliary obstruction. B, Forest plot showing the clinical success rate of EUS-guided biliary drainage in the management of biliary obstruction.

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