{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T15:02:33Z","timestamp":1787238153847,"version":"build-2736575974"},"reference-count":69,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2026,1,10]],"date-time":"2026-01-10T00:00:00Z","timestamp":1768003200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,1,10]],"date-time":"2026-01-10T00:00:00Z","timestamp":1768003200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["UEG Journal"],"published-print":{"date-parts":[[2026,2]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>Endoscopic ultrasound\u2010guided biliary drainage (EUS\u2010BD) has evolved from a rescue therapy into a viable alternative to endoscopic retrograde cholangiopancreatography (ERCP) and percutaneous drainage for distal malignant biliary obstruction (dMBO). Among the available techniques, EUS\u2010guided choledochoduodenostomy (EUS\u2010CDS) has become the preferred approach, supported by expanding evidence, and wider adoption beyond expert centres. EUS\u2010guided hepaticogastrostomy (EUS\u2010HGS) currently retains a role in high\u2010volume centres and in patients with combined biliary and duodenal obstruction, while other approaches, including EUS\u2010guided gallbladder drainage, antegrade stenting, and rendezvous procedures, are applied selectively due to limited evidence or narrower applicability. This review summarizes the current role of EUS\u2010BD in dMBO, with emphasis on EUS\u2010CDS. Technical and clinical considerations, training requirements, and remaining challenges are discussed, and future perspectives are outlined, focusing on device innovation and patient\u2010centred outcomes to guide safe and structured integration of EUS\u2010BD into clinical practice.<\/jats:p>","DOI":"10.1002\/ueg2.70166","type":"journal-article","created":{"date-parts":[[2026,1,10]],"date-time":"2026-01-10T16:29:58Z","timestamp":1768062598000},"source":"Crossref","is-referenced-by-count":4,"title":["Changing the Flow: How EUS\u2010Guided Drainage is Reshaping the Management of Distal Malignant Biliary Obstruction"],"prefix":"10.1002","volume":"14","author":[{"given":"Jeska A.","family":"Fritzsche","sequence":"first","affiliation":[{"name":"Department of Gastroenterology and Hepatology Amsterdam UMC Location University of Amsterdam  Amsterdam the Netherlands"},{"name":"Cancer Center Amsterdam  Amsterdam the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Inge","family":"de Vries","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology Amsterdam UMC Location University of Amsterdam  Amsterdam the Netherlands"},{"name":"Cancer Center Amsterdam  Amsterdam the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeanin E.","family":"van Hooft","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology Leiden University Medical Center  Leiden the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9969-019X","authenticated-orcid":false,"given":"Rogier P.","family":"Voermans","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology Amsterdam UMC Location University of Amsterdam  Amsterdam the Netherlands"},{"name":"Cancer Center Amsterdam  Amsterdam the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roy L. 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