2020 Volume 34 Issue 4 Pages 648-656
Endoscopic ultrasound/endosonography guided-biliary drainage (EUS-BD) is now covered by the Japanese insurance and the clinical practice guidelines were recently published, but EUS-BD has not been standardized yet. For safe performance of EUS-BD as well as safe introduction of the procedure to non-expert centers, there are some hurdles such as the lack of dedicated devices, needs for technical skills and potential risks of severe adverse events. Since there are few currently available evidences, the clinical practice guidelines were mainly based on expert opinion, not high level evidences, and there still remain many important issues. Establishment of technical terms and classification of procedures are required urgently and many clinical trials are mandatory to define indications, device selection and management of adverse events. Furthermore, consensus are necessary to establish the methods of education and introduction to non-experts and their centers. We should conduct clinical trials to make high quality evidences and hopefully Japanese endoscopists will lead the global situations and contribute to the safe spread this procedure all over the world.
