Background and Aims: Periampullary malignancies often present at an advanced unresectable stage requiring palliation of symptoms for the better quality of life. Though they require multispecialty support; role of endoscopic interventions in palliation is paramount because of the advancement in technology and increase experience of Gastroenterologist. Methods: We did extensive review of articles regarding endoscopic advances in the management of Unresectable Periampullary Malignancies. Several systematic reviews, Meta analysis, and Randomized controlled trials published over the last 2 decades were thoroughly searched on PUBMED and GOOGLE SCHOLAR. Results: Advanced Endoscopic procedures have been emerging as a superior modality than conventional measures because of minimal invasiveness and greater clinical and technical success. Conclusion: Periampullary malignancies often present at an advanced unresectable stage requiring palliation of symptoms for the better quality of life. Several endoscopic interventions have already been established as the standard of care in palliation of symptoms of unresectable periampullary malignancies, we can say with confidence that with growing advances in EUS, advancement in technologies and increasing experiences, the role of gastroenterologist will be pivotal in these groups of patients.
Mertz, H.R., Sechopoulos, P., Delbeke, D. and Leach, S.D. (2000) EUS, PET, and CT Scanning for Evaluation of Pancreatic Adenocarcinoma. Gastrointestinal Endoscopy, 52, 367-371. https://doi.org/10.1067/mge.2000.107727
Hunt, G.C. and Faigel, D.O. (2002) Assessment of EUS for Diagnosing, Staging, and Determining Resectability of Pancreatic Cancer: A Review. Gastrointestinal Endoscopy, 55, 232-237. https://doi.org/10.1067/mge.2002.121342
Yan, B.M. and Myers, R.P. (2007) Neurolytic Celiac Plexus Block for Pain Control in Unresectable Pancreatic Cancer. American Journal of Gastroenterology, 102, 430-438. https://doi.org/10.1111/j.1572-0241.2006.00967.x
Collins, D., Penman, I., Mishra, G. and Draganov, P. (2006) EUS-Guided Celiac Block and Neurolysis. Endoscopy, 38, 935-939. https://doi.org/10.1055/s-2006-944734
Michaels, A.J. and Draganov, P.V. (2007) Endoscopic Ultrasonography Guided Celiac Plexus Neurolysis and Celiac Plexus Block in the Management of Pain Due to Pancreatic Cancer and Chronic Pancreatitis. World Journal of Gastroenterology, 13, 3575-3580. https://doi.org/10.3748/wjg.v13.i26.3575
Schmulewitz, N. and Hawes, R. (2003) EUS-Guided Celiac Plexus Neurolysis—Technique and Indication. Endoscopy, 35, S49-S53. https://doi.org/10.1055/s-2003-41530
Minaga, K., Takenaka, M., Kamata, K., et al. (2018) Alleviating Pancreatic Cancer-Associated Pain Using Endoscopic Ultrasound-Guided Neurolysis. Cancers, 10, Article No. 50. https://doi.org/10.3390/cancers10020050
Kothari, T.H., Kothari, S. and Kaul, V. (2019). EUS-Guided Celiac Plexus Block and Celiac Plexus Neurolysis. In: Adler, D.G., Ed., Interventional Endoscopic Ultrasound, Springer, Cham, 65-72. https://doi.org/10.1007/978-3-319-97376-0_7
Faigel, D.O., Veloso, K.M., Long, W.B., et al. (1996) Endosonography-Guided Celiac Plexus Injection for Abdominal Pain Due to Chronic Pancreatitis. The American Journal of Gastroenterology, 91, 1675.
Yasuda, I., Doi, S. and Mabuchi, M. (2019) EUS-Guided Celiac Plexus Neurolysis. In: Mine, T. and Fujita, R., Eds., Advanced Therapeutic Endoscopy for Pancreatico-Biliary Diseases, Springer, Tokyo, 159-175. https://doi.org/10.1007/978-4-431-56009-8_14
Sakamoto, H., Kitano, M., Kamata, K., Komaki, T., Imai, H., Chikugo, T., Takeyama, Y. and Kudo, M. (2010) EUS-Guided Broad Plexus Neurolysis over the Superior Mesenteric Artery Using a 25-Gauge Needle. American Journal of Gastroenterology, 105, 2599-2606. https://doi.org/10.1038/ajg.2010.339
Levy, M.J., Topazian, M.D., Wiersema, M.J., Clain, J.E., Rajan, E., Wang, K.K., De La Mora, J.G., Gleeson, F.C., Pearson, R.K., Pelaez, M.C., Petersen, B.T., Vege, S.S. and Chari, S.T. (2008) Initial Evaluation of the Efficacy and Safety of Endoscopic Ultrasound-Guided Direct Ganglia Neurolysis and Block. American Journal of Gastroenterology, 103, 98-103. https://doi.org/10.1111/j.1572-0241.2007.01607.x
Pérez-Aguado, G., De La Mata, D.M., Valenciano, C.M. and Sainz, I.F. (2021) Endoscopic Ultrasonography-Guided Celiac Plexus Neurolysis in Patients with Unresectable Pancreatic Cancer: An Update. World Journal of Gastrointestinal Endoscopy, 13, 460-472. https://doi.org/10.4253/wjge.v13.i10.460
Asif, A., Walayat, S., Bechtold, M., et al. (2009) EUS-Guided Celiac Plexus Neurolysis for Pain in Pancreatic Cancer Patients: A Meta-Analysis and Systematic Review. Digestive Diseases and Sciences, 54, 2330-2337. https://doi.org/10.1007/s10620-008-0651-x
Sahai, A.V., Lemelin, V., Lam, E. and Paquin, S.C. (2009) Central vs. Bilateral Endoscopic Ultrasound-Guided Celiac Plexus Block or Neurolysis: A Comparative Study of Short-Term Effectiveness. American Journal of Gastroenterology, 104, 326-329. https://doi.org/10.1038/ajg.2008.64
Doi, S., Yasuda, I., Kawakami, H., Hayashi, T., Hisai, H., Irisawa, A., Mukai, T., Katanuma, A., Kubota, K., Ohnishi, T., Ryozawa, S., Hara, K., Itoi, T., Hanada, K. and Yamao, K. (2013) Endoscopic Ultrasound-Guided Celiac Ganglia Neurolysis vs. Celiac Plexus Neurolysis: A Randomized Multicenter Trial. Endoscopy, 45, 362-369. https://doi.org/10.1055/s-0032-1326225
Kamata, K., Kinoshita, M., Kinoshita, I., et al. (2022) Efficacy of EUS-Guided Celiac Plexus Neurolysis in Combination with EUS-Guided Celiac Ganglia Neurolysis for Pancreatic Cancer-Associated Pain: A Multicenter Prospective Trial. International Journal of Clinical Oncology, 27, 1196-1201. https://doi.org/10.1007/s10147-022-02160-6
Levy,M., Gleeson,F., Topazian, M., et al. (2019) Combined Celiac Ganglia and Plexus Neurolysis Shortens Survival, without Benefit, vs. Plexus Neurolysis Alone. Clinical Gastroenterology and Hepatology, 17, 728-738.e9. https://doi.org/10.1016/j.cgh.2018.08.040
Bartlett, E.K., Wachtel, H., Fraker, D.L., Vollmer, C.M., Drebin, J.A., Kelz, R.R., Karakousis, G.C. and Roses, R.E. (2014) Surgical Palliation for Pancreatic Malignancy: Practice Patterns and Predictors of Morbidity and Mortality. Journal of Gastrointestinal Surgery, 18, 1292-1298. https://doi.org/10.1007/s11605-014-2502-8
Kohan, G., Ocampo, C.G., Zandalazini, H.I., Klappenbach, R., Yazyi, F., Ditulio, O., Coturel, A., Canullán, C., Porras, L.T.C. and Rodriguez, J.A. (2015) Laparoscopic Hepaticojejunostomy and Gastrojejunostomy for Palliative Treatment of Pancreatic Head Cancer in 48 Patients. Surgical Endoscopy, 29, 1970-1975. https://doi.org/10.1007/s00464-014-3894-y
Lyons, J.M., Karkar, A., Correa-Gallego, C.C., D’Angelica, M.I., DeMatteo, R.P., Fong, Y., Kingham, T.P., Jarnagin, W.R., Brennan, M.F. and Allen, P.J. (2012) Operative Procedures for Unresectable Pancreatic Cancer: Does Operative Bypass Decrease Requirements for Postoperative Procedures and In-Hospital Days? HPB, 14, 469-475. https://doi.org/10.1111/j.1477-2574.2012.00477.x
Kim, K.O., Kim, T.N. and Lee, H.C. (2012) Effectiveness of Combined Biliary and Duodenal Stenting in Patients with Malignant Biliary and Duodenal Obstruction. Scandinavian Journal of Gastroenterology, 47, 962-967. https://doi.org/10.3109/00365521.2012.677956
Ross, W.A., Wasan, S.M., Evans, D.B., et al. (2008) Combined EUs with FNA and ERCP for the Evaluation of Patients with Obstructive Jaundice from Presumed Pancreatic Malignancy. Gastrointestinal Endoscopy, 68, 461-466. https://doi.org/10.1016/j.gie.2007.11.033
Davids, P.H.P., Groen, A.K., Rauws, E.A., Tytgat, G.N. and Huibregtse, K. (1992) Randomized Trial of Self-Expanding Metal Stents versus Polyethylene Stents for Distal Malignant Biliary Obstruction. Lancet, 340, 1488-1492. https://doi.org/10.1016/0140-6736(92)92752-2
Knyrim, K., Wagner, H.J., Pausch, J. and Vakil, N. (1993) A Prospective, Randomized, Controlled Trial of Metal Stents for Malignant Obstruction of the Common Bile Duct. Endoscopy, 25, 207-212. https://doi.org/10.1055/s-2007-1010294
Prat, F., Chapat, O., Ducot, B., Ponchon, T., Pelletier, G., Fritsch, J., Choury, A.D. and Buffet, C. (1998) A Randomized Trial of Endoscopic Drainage Methods for Inoperable Malignant Strictures of the Common Bile Duct. Gastrointestinal Endoscopy, 47, 1-7. https://doi.org/10.1016/S0016-5107(98)70291-3
Isayama, H., Yasuda, I., Ryozawa, S., Maguchi, H., Igarashi, Y., Matsuyama, Y., Katanuma, A., Hasebe, O., Irisawa, A., Itoi, T., et al. (2011) Results of a Japanese Multicenter, Randomized Trial of Endoscopic Stenting for Non-Resectable Pancreatic Head Cancer (JM-Test): Covered Wallstent versus DoubleLayer Stent. Digestive Endoscopy, 23, 310-315. https://doi.org/10.1111/j.1443-1661.2011.01124.x
Hayashi, T., Kawakami, H., Osanai, M., Ishiwatari, H., Naruse, H., Hisai, H., Yanagawa, N., Kaneto, H., Koizumi, K., Sakurai, T., et al. (2015) No Benefit of Endoscopic Sphincterotomy before Biliary Placement of Self-Expandable Metal Stents for Unresectable Pancreatic Cancer. Clinical Gastroenterology and Hepatology, 13, 1151-1158. https://doi.org/10.1016/j.cgh.2015.01.008
Isayama, H., Komatsu, Y., Tsujino, T., Sasahira, N., Hirano, K., Toda, N., Nakai, Y., Yamamoto, N., Tada, M., Yoshida, H., et al. (2004) A Prospective Randomised Study of “Covered” versus “Uncovered” Diamond Stents for the Management of Distal Malignant Biliary Obstruction. Gut, 53, 729-734. https://doi.org/10.1136/gut.2003.018945
Kitano, M., Yamashita, Y., Tanaka, K., Konishi, H., Yazumi, S., Nakai, Y., Nishiyama, O., Uehara, H., Mitoro, A., Sanuki, T., et al. (2013) Covered Self-Expandable Metal Stents with an Anti-Migration System Improve Patency Duration without Increased Complications Compared with Uncovered Stents for Distal Biliary Obstruction Caused by Pancreatic Carcinoma: A Randomized Multicenter Trial. American Journal of Gastroenterology, 108, 1713-1722. https://doi.org/10.1038/ajg.2013.305
Tanisaka, Y., Ryozawa, S., Mizuide, M., Fujita, A., Ogawa, T., Tashima, T., Noguchi, T., Suzuki, M., Katsuda, H. and Araki, R. (2021) Usefulness of Self-Expandable Metal Stents for Malignant Biliary Obstruction Using a Short-Type Single-Balloon Enteroscope in Patients with Surgically Altered Anatomy. Journal of Hepato-Biliary-Pancreatic Sciences, 28, 272-279. https://doi.org/10.1002/jhbp.889
Lee, J.H., Krishna, S.G., Singh, A., Ladha, H.S., Slack, R.S., Ramireddy, S., Raju, G.S., Davila, M. and Ross, W.A. (2013) Comparison of the Utility of Covered Metal Stents Versus Uncovered Metal Stents in the Management of Malignant Biliary Strictures in 749 Patients. Comparison of the Utility of Covered Metal Stents versus Uncovered Metal Stents in the Management of Malignant Biliary Strictures in 749 Patients. Gastrointestinal Endoscopy, 78, 312-324. https://doi.org/10.1016/j.gie.2013.02.032
Tanisaka, Y., Mizuide, M., Fujita, A., Ogawa, T., Katsuda, H., Saito, Y., et al. (2021) Current Status of Endoscopic Biliary Drainage in Patients with Distal Malignant Biliary Obstruction. Journal of Clinical Medicine, 10, Article No. 4619. https://doi.org/10.3390/jcm10194619
Telford, J.J., Carr-Locke, D.L., Baron, T.H., Poneros, J.M., Bounds, B.C., Kelsey, P.B., Schapiro, R.H., Huang, C.S., Lichtenstein, D.R., Jacobson, B.C., et al. (2010) A Randomized Trial Comparing Uncovered and Partially Covered Self-Expandable Metal Stents in the Palliation of Distal Malignant Biliary Obstruction. Gastrointestinal Endoscopy, 72, 907-914. https://doi.org/10.1016/j.gie.2010.08.021
Kullman, E., Frozanpor, F., Söderlund, C., Linder, S., Sandström, P., Lindhoff-Larsson, A., Toth, E., Lindell, G., Jonas, E., Freedman, J., et al. (2010) Covered Versus Uncovered Self-Expandable Nitinol Stents in the Palliative Treatment of Malignant Distal Biliary Obstruction: Results from a Randomized, Multicenter Study. Gastrointestinal Endoscopy, 72, 915-923. https://doi.org/10.1016/j.gie.2010.07.036
Lee, S.J., Kim, M.D., Lee, M.S., Kim, I.J., Park, S.I., Won, J.Y. and Lee, D.Y. (2014) Comparison of the Efficacy of Covered Versus Uncovered Metallic Stents in Treating Inoperable Malignant Common Bile Duct Obstruction: A Randomized Trial. Journal of Vascular and Interventional Radiology, 25, 1912-1920. https://doi.org/10.1016/j.jvir.2014.05.021
Tringali, A., Didden, P., Repici, A., Spaander, M., Bourke, M.J., Williams, S.J., Spicak, J., Drastich, P., Mutignani, M., Perri, V., Roy, A., Johnston, K. and Costamagna, G. (2014) Endoscopic Treatment of Malignant Gastric and Duodenal Strictures: A Prospective, Multicenter Study. Gastrointestinal Endoscopy, 79, 66-75. https://doi.org/10.1016/j.gie.2013.06.032
Costamagna, G., Tringali, A., Spicak, J., Mutignani, M., Shaw, J., Roy, A., Johnsson, E., De Moura, E.G., Cheng, S., Ponchon, T., Bittinger, M., Messmann, H., Neuhaus, H., Schumacher, B., Laugier, R., Saarnio, J. and Ariqueta, F.I. (2012) Treatment of Malignant Gastroduodenal Obstruction with a Nitinol Self-Expanding Metal Stent: An International Prospective Multicentre Registry. Digestive and Liver Disease, 44, 37-43. https://doi.org/10.1016/j.dld.2011.08.012
Khashab, M., Alawad, A.S., Shin, E.J., Kim, K., Bourdel, N., Singh, V.K., Lennon, A.M., Hutfless, S., Sharaiha, R.Z., Amateau, S., Okolo, P.I., Makary, M.A., Wolfgang, C., Canto, M.I. and Kalloo, A.N. (2013) Enteral Stenting Versus Gastrojejunostomy for Palliation of Malignant Gastric Outlet Obstruction. Surgical Endoscopy, 27, 2068-2075. https://doi.org/10.1007/s00464-012-2712-7
Hori, Y., Naitoh, I., Ban, T., Narita, K., Nakazawa, T., Hayashi, K., Miyabe, K., Shimizu, S., Kondo, H., Nishi, Y., Yoshida, M., Umemura, S., Kato, A., Yamada, T., Ando, T. and Joh, T. (2015) Stent Under-Expansion on the Procedure Day, A Predictive Factor for Poor Oral Intake After Metallic Stenting for Gastric Outlet Obstruction. Journal of Gastroenterology and Hepatology, 30, 1246-1251. https://doi.org/10.1111/jgh.12933
Lee, K.M., Choi, S.J., Shin, S.J., Hwang, J.C., Lim, S.G., Jung, J.Y., Yoo, B.M., Cho, S.W. and Kim, J.H. (2009) Palliative Treatment of Malignant Gastroduodenal Obstruction with Metallic Stent: Prospective Comparison of Covered and Uncovered Stents. Scandinavian Journal of Gastroenterology, 44, 846-852. https://doi.org/10.1080/00365520902929849
Park, C.H., Park, J.C., Kim, E.H., Chung, H., An, J.Y., Kim, H.I., Shin, S.K., Lee, S.K., Cheong, J.H., Hyung, W.J., Lee, Y.C., Noh, S.H. and Kim, C.B. (2015) Impact of Carcinomatosis and Ascites Status on Long-Term Outcomes of Palliative Treatment for Patients with Gastric Outlet Obstruction Caused by Unresectable Gastric Cancer: Stent Placement Versus Palliative Gastrojejunostomy. Gastrointestinal Endoscopy, 81, 321-332. https://doi.org/10.1016/j.gie.2014.06.024
Brimhall, B. and Adler, D.G. (2011) Enteral Stents for Malignant Gastric Outlet Obstruction. Gastrointestinal Endoscopy Clinics of North America, 21, 389-403. https://doi.org/10.1016/j.giec.2011.04.002
Jeurnink, S.M., Repici, A., Luigiano, C., Pagano, N., Kuipers, E.J. and Siersema, P.D. (2009) Use of a Colonoscope for Distal Duodenal Stent Placement in Patients with Malignant Obstruction. Surgical Endoscopy, 23, 562-567. https://doi.org/10.1007/s00464-008-9880-5
Park, J.M., Min, B.H., Lee, S.H., Chung, K.H., Lee, J.M., Song, B.J., Lee, J.K., Ryu, J.K. and Kim, Y.T. (2015) Feasibility of Self-Expandable Metal Stent Placement with Side-Viewing Endoscope for Malignant Distal Duodenal Obstruction. Digestive Diseases and Sciences, 60, 524-530. https://doi.org/10.1007/s10620-014-3343-8
ASGE Technology Committee, Varadarajulu, S., Banerjee, S., Barth, B., Desilets, D., Kaul, V., Kethu, S., Pedrosa, M., Pfau, P., Tokar, J., Wang, A., Song, L.M. and Rodriguez, S. (2011) Enteral Stents. Gastrointestinal Endoscopy, 74, 455-464. https://doi.org/10.1016/j.gie.2011.04.011
van Halsema, E.E., Rauws, E.A., Fockens, P. and Van Hooft, J.E. (2015) Self-Expandable Metal Stents for Malignant Gastric Outlet Obstruction: A Pooled Analysis of Prospective Literature. World Journal of Gastroenterology, 21, 12468-12481. https://doi.org/10.3748/wjg.v21.i43.12468
Adler, D.G. and Baron, T.H. (2002) Endoscopic Palliation of Malignant Gastric Outlet Obstruction Using Self-Expanding Metal Stents: Experience in 36 Patients. American Journal of Gastroenterology, 97, 72-78. https://doi.org/10.1111/j.1572-0241.2002.05423.x
Jeurnink, S.M., Van Eijck, C.H., Steyerberg, E.W., Kuipers, E.J. and Siersema, P.D. (2007) Stent versus Gastrojejunostomy for the Palliation of Gastric Outlet Obstruction: A Systematic Review. BMC Gastroenterology, 7, Article No. 18. https://doi.org/10.1186/1471-230X-7-18
Jeon, H.H., Park, C.H., Park, J.C., Shim, C.N., Kim, S., Lee, H.J., Lee, H., Shin, S.K., Lee, S.K. and Lee, Y.C. (2014) Carcinomatosis Matters: Clinical Outcomes and Prognostic Factors for Clinical Success of Stent Placement in Malignant Gastric Outlet Obstruction. Surgical Endoscopy, 28, 988-995. https://doi.org/10.1007/s00464-013-3268-x
Grunwald, D., Cohen, J., Bartley, A., Sheridan, J., Chuttani, R., Sawhney, M.S., Pleskow, D.K., Berzin, T.M. and Mizrahi, M. (2016) The Location of Obstruction Predicts Stent Occlusion in Malignant Gastric Outlet Obstruction. Therapeutic Advances in Gastroenterology, 9, 815-822. https://doi.org/10.1177/1756283X16667893
Mutignani, M., Tringali, A., Shah, S.G., Perri, V., Familiari, P., Iacopini, F., Spada, C. and Costamagna, G. (2007) Combined Endoscopic Stent Insertion in Malignant Biliary and Duodenal Obstruction. Endoscopy, 39, 440-447. https://doi.org/10.1055/s-2007-966327
Staub, J., Siddiqui, A., Taylor, L.J., Loren, D., Kowalski, T. and Adler, D.G. (2018) ERCP Performed through Previously Placed Duodenal Stents: A Multicenter Retrospective Study of Outcomes and Adverse Events. Gastrointestinal Endoscopy, 87, 1499-1504. https://doi.org/10.1016/j.gie.2018.01.040
Yao, J.F., Zhang, L. and Wu, H. (2016) Analysis of High Risk Factors for Endoscopic Retrograde Cholangiopancreatography Biliary Metallic Stenting After Malignant Duodenal Stricture SEMS Implantation. Journal of Biological Regulators and Homeostatic Agents, 30, 743-748. https://doi.org/10.1007/s00464-012-2585-9
Hamada, T., Nakai, Y., Isayama, H., Sasaki, T., Kogure, H., Kawakubo, K., Sasahira, N., Yamamoto, N., Togawa, O., Mizuno, S., et al. (2013) Duodenal Metal Stent Placement Is a Risk Factor for Biliary Metal Stent Dysfunction: An Analysis Using a Time-Dependent Covariate. Surgical Endoscopy, 27, 1243-1248. https://doi.org/10.1007/s00464-012-2585-9
Anderloni, A., Troncone, E., Fugazza, A., Cappello, A., Blanco, G.D.V., Monteleone, G. and Repici, A. (2019) Lumen-Apposing Metal Stents for Malignant Biliary Obstruction: Is This the Ultimate Horizon of Our Experience? World Journal of Gastroenterology, 25, 3857-3869. https://doi.org/10.3748/wjg.v25.i29.3857
Anderloni, A., Buda, A., Carrara, S., Di Leo, M., Fugazza, A., Maselli, R. and Repici, A. (2016) Single-Session Double-Stent Placement in Concomitant Malignant Biliary and Duodenal Obstruction with a Cautery-Tipped Lumen Apposing Metal Stent. Endoscopy, 48, E321-E322. https://doi.org/10.1055/s-0042-117425
Anderloni, A., Fugazza, A., Auriemma, F., Maia, L., Maselli, R., Troncone, E., D'Amico, F. and Repici, A. (2018) Cautery-Tipped Lumen Apposing Metal Stent Placement through the Mesh of an Indwelling Duodenal Self-Expanding Metal Stent. American Journal of Gastroenterology, 113, 644. https://doi.org/10.1038/s41395-018-0040-9
Yamao, K., Kitano, M., Takenaka, M., Minaga, K., Sakurai, T., Watanabe, T., Kayahara, T., Yoshikawa, T., Yamashita, Y., Asada, M., Okabe, Y., Hanada, K., Chiba, Y. and Kudo, M. (2018) Outcomes of Endoscopic Biliary Drainage in Pancreatic Cancer Patients with an Indwelling Gastroduodenal Stent: A Multicenter Cohort Study in West Japan. Gastrointestinal Endoscopy, 88, 66-75.e2. https://doi.org/10.1016/j.gie.2018.01.021
Han, S., Kim, S., So, H., et al. (2019) EUS-Guided Biliary Drainage versus ERCP for First-Line Palliation of Malignant Distal Biliary Obstruction: A Systematic Review and Meta-Analysis. Scientific Reports, 9, Article No. 16551. https://doi.org/10.1038/s41598-019-52993-x
Paik, W.H., Lee, T.H., Park, D.H., Choi, J.H., Kim, S.O., Jang, S., et al. (2018) EUS-Guided Biliary Drainage versus ERCP for the Primary Palliation of Malignant Biliary Obstruction: A Multicenter Randomized Clinical Trial. American Journal of Gastroenterology, 113, 987-997. https://doi.org/10.1038/s41395-018-0122-8
Hatamaru, K. and Kitano, M. (2019) EUS-Guided Biliary Drainage for Difficult Cannulation. Endosc Ultrasound, 8, S67-S71. https://doi.org/10.4103/eus.eus_60_19
Chandan, S., Khan, S.R., Mohan, B.P., Shah, A.R., Bilal, M., Ramai, D., Bhogal, N., Dhindsa, B., Kassab, L.L., Singh, S., et al. (2021) EUS-Guided Gastroenterostomy versus Enteral Stenting for Gastric Outlet Obstruction: Systematic Review and Meta-Analysis. Endoscopy International Open, 9, E496-E504. https://doi.org/10.1055/a-1341-0788