Evaluation of clinical success and adverse events with endoscopic ultrasound-guided biliary drainage (EUS-BD) compared to percutaneous transhepatic biliary drainage (PTBD) after failed ERCP in malignant biliary obstruction: A systematic review and meta-analysis.

Key Takeaways for GI Nurses

• When ERCP fails to provide biliary drainage in malignant obstruction cases (occurring in 3-10% of procedures), nurses should be prepared to support patients through alternative interventions like EUS-guided biliary drainage or percutaneous transhepatic biliary drainage
• Understanding the comparative outcomes between EUS-BD and PTBD helps nurses anticipate different recovery trajectories, potential complications, and post-procedure care requirements for each approach
• Failed ERCP cases require heightened patient monitoring and emotional support, as patients face extended procedures and potential transfers between departments or facilities for alternative drainage methods
• Familiarity with both endoscopic and interventional radiology drainage techniques enhances nurse advocacy and patient education capabilities when discussing treatment options with patients and families

Clinical Relevance

This systematic review addresses a critical junction in malignant biliary obstruction management that directly impacts endoscopy nursing practice. When ERCP fails, nurses play a pivotal role in coordinating care transitions and managing patient expectations. The comparison between EUS-guided biliary drainage and percutaneous approaches helps nurses understand the risk-benefit profiles of each alternative, enabling more informed patient discussions and preparation for different post-procedure care pathways.

From an operational perspective, failed ERCP cases often extend procedure times and require additional resources. Nurses must be prepared to support prolonged procedures when EUS-BD is attempted as a same-session rescue technique, including monitoring sedation requirements and patient stability. Alternatively, when PTBD is selected, nurses coordinate transfers to interventional radiology and manage the transition between departments while maintaining continuity of patient advocacy and communication with families.

The evidence synthesis also supports professional development initiatives around advanced endoscopic techniques. As EUS-guided interventions become more prevalent, endoscopy nurses benefit from understanding the technical aspects, equipment requirements, and unique complications associated with these procedures. This knowledge enhances clinical competency and positions nurses as valuable team members in complex therapeutic endoscopy programs.

Bottom Line

While ERCP failure in malignant biliary obstruction affects a relatively small percentage of cases, it represents a high-stakes clinical scenario where nursing expertise in patient advocacy, care coordination, and technical support becomes crucial. This meta-analysis provides evidence-based insights that help endoscopy nurses better understand alternative drainage options, anticipate patient needs, and contribute meaningfully to multidisciplinary decision-making when standard endoscopic approaches fail.