Endoscopic ultrasound-guided biliary drainage in malignant distal biliary obstruction

Abstract

Endoscopic retrograde cholangiopancreatography is the standard therapeutic approach for malignant distal biliary obstruction (MDBO). However, it can be challenging in patients with surgically altered anatomy, pyloric/duodenal obstruction, or failed biliary cannulation. Since the development of endoscopic ultrasound (EUS), EUS-guided biliary drainage (EUS-BD) has been increasingly performed. The current article provides a concise review of the latest practices and techniques of EUS-BD procedures for MDBO including EUS-assisted rendezvous, EUS-guided antegrade stenting, EUSguided choledochoduodenostomy, and EUS-guided hepaticogastrostomy.