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Recently, it has been adopted as a primary biliary drainage method, and its indications have expanded. Since EUS\u2010BD can cause adverse events (AEs), such as bile leakage and stent migration, which do not occur in endoscopic retrograde cholangiopancreatography, endoscopists need to be well\u2010versed in its management and preventive techniques. EUS\u2010BD includes several procedures, such as EUS\u2010guided choledochoduodenostomy (EUS\u2010CDS), EUS\u2010guided hepaticogastrostomy (EUS\u2010HGS), EUS\u2010guided antegrade stenting (EUS\u2010AS), and EUS\u2010guided rendezvous (EUS\u2010RV). A recent meta\u2010analysis reported that the overall AE rate of EUS\u2010BD was 13.7% (EUS\u2010CDS, 11.9%; EUS\u2010HGS, 15.5%; EUS\u2010AS, 9.9%; and EUS\u2010RV, 8.8%). Among various EUS\u2010BD techniques, EUS\u2010CDS and EUS\u2010HGS are the most frequently reported. Tubular self\u2010expandable metal stents have been traditionally used in EUS\u2010CDS; however, lumen\u2010apposing metal stents have recently gained popularity. A systematic review showed that the rates of early AEs were similar between self\u2010expandable metal stents\u00a0and lumen\u2010apposing metal stents; however, stent maldeployment was more problematic with lumen\u2010apposing metal stents. Although tubular self\u2010expandable metal stents are used in EUS\u2010HGS, stent maldeployment remains a serious issue, and available devices and technical tips for preventing this AE should be well understood. Furthermore, AEs, such as sepsis, cholangitis, and bleeding, can occur, and strategies to mitigate these risks are essential. In this narrative review, we discussed AEs related to EUS\u2010BD with a focus on management options and strategies for prevention.<\/jats:p>","DOI":"10.1002\/deo2.70145","type":"journal-article","created":{"date-parts":[[2025,5,23]],"date-time":"2025-05-23T02:25:21Z","timestamp":1747967121000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":17,"title":["Prevention of Adverse Events in Endoscopic Ultrasound\u2010Guided Biliary Drainage"],"prefix":"10.1002","volume":"6","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6719-4466","authenticated-orcid":false,"given":"Hirotoshi","family":"Ishiwatari","sequence":"first","affiliation":[{"name":"Division of Endoscopy Shizuoka Cancer Center  Shizuoka Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiroki","family":"Sakamoto","sequence":"additional","affiliation":[{"name":"Division of Endoscopy Shizuoka Cancer Center  Shizuoka 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