Endoscopic retrograde cholangiopancreatography (ERCP) is now considered as the first-line modality for biliary drainage. However, it is limited by failure rate to achieve bile duct access of 3%-5%. In such cases with failure of access to the bile duct, percutaneous transhepatic biliary drainage (PTBD) is needed. Unfortunately, PTBD is associated with a high rate of complications. Endoscopic ultrasound-guided biliary drainage (EUS-BD) has been introduced as an effective alternative to PTBD in patients with failure of ERCP. Little is known, however, about the long-term outcomes of EUS-BD performed with a fully covered self-expandable metallic stent (FCSEMS) . We examined the long-term outcomes of EUS-BD performed with an FCSEMS. From August 2010 to October 2013, EUS-BD was performed in 8 patients with distal malignant biliary obstructions. The technical success rate was 100%. The stent patency was maintained in 5 (62.5%) patients until their death, while distal migration of the stent occurred during the follow-up period in the remaining 3 (37.5%) patients. In 2 of these patients, the FCSEMS could be easily reinserted, because the opening of the fistula tract was large enough to be easily found, even after the stent migration. In conclusion, EUS-BD is a safe and effective method in patients with distal malignant biliary obstruction and the stent patency is maintained for a long duration in a high percentage of the patients. However, the distal stent migration rate was significantly high, suggesting the need for a newly designed metallic stent for performing EUS-BD.
