NICE has been notified about this procedure and it is part of its work programme. The Interventional Procedures Advisory Committee (IPAC) will consider this procedure and NICE will issue an interventional procedures consultation document about its safety and efficacy for 4 weeks’ public consultation. IPAC will then review the consultation document in the light of comments received and produce a final interventional procedures document, which will be considered by NICE before guidance is issued to the NHS in England, Wales, Scotland and Northern Ireland.
Status Awaiting development
Technology type Procedure
Decision Selected
Reason for decision Anticipate the topic will be of importance to patients, carers, professionals, commissioners and the health of the public to ensure clinical benefit is realised, inequalities in use addressed, and help them make the best use of NHS resources
Process IP
ID number 1879
Description Endoscopic ultrasound-guided biliary drainage (EUS-BD) is used as an alternative to endoscopic retrograde cholangiopancreatography (ERCP) when the latter is not possible because of the nature of the obstruction or patient anatomy. EUS-BD may also serve as a minimally invasive alternative to percutaneous biliary drainage (PTBD) which is conventionally offered in cases where ERCP has failed. The aim of the procedure is to reduce biliary obstruction and allow the biliary tract to drain normally. Endoscopic ultrasound-guided biliary drainage (EUS-BD) may be done with the patient under conscious sedation or general anaesthesia and involves inserting an echoendoscope through the mouth and oesophagus into the stomach or duodenum, depending on the technique. Using ultrasound guidance, the biliary tract is punctured with a needle. A contrast agent may be injected to enhance imaging. A guidewire is then passed into the biliary tract at the site of the puncture, which is dilated to create a fistula. Finally, a metal or plastic stent is deployed between the biliary tract and the intestine to allow for biliary drainage into the stomach or small intestine. Stent delivery systems may also be used to complete EUS-BD without the need for needle puncture, dilation, or insertion of guidewire. EUS-BD can be done using several different techniques and access routes, but the two most common techniques both use a transluminal approach. The first is EUS-guided choledochoduodenostomy (EUS-CDS), in which the extrahepatic bile duct is punctured, and stent deployed from the duodenal bulb. The second is EUS-guided hepaticogastrostomy (EUS-HGS) in which the left hepatic duct is punctured, and stent deployed via the stomach. Stents may also be deployed using a transpapillary approach in which the guidewire is passed into the duodenum via the papilla. In an EUS-guided antegrade approach (EUS-AGS), the stent is placed across the biliary obstruction, while in the EUS-guided rendezvous technique (EUS-RV), the echoendoscope is swapped with an ERCP duodenoscope following placement of the guidewire and a conventional ERCP is done before stent placement.

Provisional Schedule

IPAC 1 13 October 2022
Interventional procedure consultation 24 November 2022 - 04 January 2023
IPAC 2 09 February 2023
Expected publication 21 April 2023

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Key events during the development of the guidance:

Date Update
23 May 2022 Awaiting development. Status change linked to Topic Selection Decision being set to Selected

For further information on how we develop interventional procedures guidance, please see our IP manual