Therapeutic endoscopic ultrasound: European Society of Gastrointestinal Endoscopy (ESGE) Technical Review.

1:  ESGE recommends a prolonged course of a prophylactic broad-spectrum antibiotic in patients with ascites who are undergoing therapeutic endoscopic ultrasound (EUS) procedures.Strong recommendation, low quality evidence. 2:  ESGE recommends placement of partially or fully covered self-expandable metal stents during EUS-guided hepaticogastrostomy for biliary drainage in malignant disease.Strong recommendation, moderate quality evidence. 3:  ESGE recommends EUS-guided pancreatic duct (PD) drainage should only be performed in high volume expert centers, owing to the complexity of this technique and the high risk of adverse events.Strong recommendation, low quality evidence. 4:  ESGE recommends a stepwise approach to EUS-guided PD drainage in patients with favorable anatomy, starting with rendezvous-assisted endoscopic retrograde pancreatography (RV-ERP), followed by antegrade or transmural drainage only when RV-ERP fails or is not feasible.Strong recommendation, low quality evidence. 5:  ESGE suggests performing transduodenal EUS-guided gallbladder drainage with a lumen-apposing metal stent (LAMS), rather than using the transgastric route, as this may reduce the risk of stent dysfunction.Weak recommendation, low quality evidence. 6:  ESGE recommends using saline instillation for small-bowel distension during EUS-guided gastroenterostomy.Strong recommendation, low quality evidence. 7:  ESGE recommends the use of saline instillation with a 19G needle and an electrocautery-enhanced LAMS for EUS-directed transgastric endoscopic retrograde cholangiopancreatography (EDGE) procedures.Strong recommendation, low quality evidence. 8:  ESGE recommends the use of either 15- or 20-mm LAMSs for EDGE, with a preference for 20-mm LAMSs when considering a same-session ERCP.Strong recommendation, low quality evidence.

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Déclaration de conflit d'intérêts

M. Barthet has received a research grant from Boston Scientific (2015 to present). K.F. Binmoeller has received fees for training and education from Boston Scientific (2015 to present). M. Bronswijk has consultancy agreements with Prion Medical and Taewoong Medical (both ongoing). M.A. Khashab receives consultancy fees from BSCI, Medtronic, Olympus, Pentax, GI Supply, and Apollo (all ongoing). A. Larghi has received consultancy fees from Boston Scientific and Pentax Medical, and educational fees from Taewoong Medical; he receives research support from Medtronic. R. Law receives consultancy fees from Medtronic (2020 to present) and Conmed (2021). M. Perez-Miranda receives consultancy fees from Lumendi and Olympus (both 2020 to present) and consultancy and speaker's fees from Boston Scientific (2021). S. van der Merwe has received consultancy fees from Boston Scientific and Cook Endoscopy (both 2012 to present); he was the Boston Chair in Interventional Endoscopy (2018 to 2021) and is the Cook Chair in Portal Hypertension (2021). J.E. van Hooft has received lecture fees from Medtronics (2014, 2015, and 2019), Cook Medical (2019), and Abbivie (2021), and consultancy fees from Boston Scientific (2014 to 2017) and Olympus (2021); her department received research support from Abbott (2014 to 2017) and Cook Medical (2014 to 2019). P.G. Arcidiacono, A. Badaoui, S. Everett, T. Hucl, R. Kunda, S. Lakhtakia, M. Rimbas, and R.L.J. van Wanrooij declare that they have no conflict of interest.