2019 Volume 61 Issue 7 Pages 1446-1457
Endoscopic retrograde cholangiopancreatography (ERCP) is now widely used as the first-choice procedure for performing biliary drainage to treat malignant biliary duct stricture. However, for cases in which performing this procedure would be difficult, endoscopic ultrasound (EUS)-guided biliary drainage (EUS-BD) and percutaneous transhepatic biliary drainage (PTBD) are also available as effective alternatives. This article provides an overview based on our experience of the EUS-BD technique and describes our approach to selection between general EUS-BD and PTBD in cases where ERCP would be difficult. Endoscopic drainage and PTBD each have limitations with respect to biliary drainage. For this reason, both the endoscopist and the interventional radiology specialist need to have a clear objective of optimal drainage, and it is therefore critical to promote establishment of a strategic partnership between these individuals.
