{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T14:02:07Z","timestamp":1783519327418,"version":"3.55.0"},"reference-count":24,"publisher":"Georg Thieme Verlag KG","issue":"08","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Endoscopy"],"published-print":{"date-parts":[[2025,8]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Biliary drainage in patients with distal malignant biliary obstruction (DMBO) carries a higher risk of difficult biliary cannulation (DBC) during endoscopic retrograde cholangiopancreatography (ERCP). After the failure of standard cannulation, endoscopists may proceed with advanced cannulation techniques and\/or with endoscopic ultrasound-guided biliary drainage (EUS-BD).<\/jats:p><jats:p>This was a retrospective study of consecutive patients with DMBO and a dilated common bile duct (CBD; &gt;12 mm) who underwent ERCP for endoscopic biliary drainage in four European centers. The rates of DBC, technical and clinical success, and procedure-related adverse events (AEs) were assessed. The predictive factors for AEs were also investigated through regression analysis. The EUS-BD approach was considered either as the first option after standard cannulation failure or as the final option after advanced cannulation failure.<\/jats:p><jats:p>1016 patients with DMBO were included in the study, with 524 (51.6%) matching the definition of DBC. Clinical success was achieved in 956 patients (94.1%). Procedure-related AEs were experienced by 167 patients (16.4%). Patients with DBC had a higher risk of AEs (P=0.003); however, patients undergoing \u201cearly\u201d EUS-BD showed a risk of AEs comparable with those managed with standard cannulation (P=0.38). An attempt at any advanced cannulation technique was independently associated with the occurrence of AEs (P=0.001).<\/jats:p><jats:p>The risk of AEs is higher in patients with DMBO and DBC, this appears to be mainly related to the advanced cannulation techniques. In patients with a dilated CBD (&gt;12 mm), \u201cearly\u201d EUS-BD may minimize the risk of AEs.<\/jats:p>","DOI":"10.1055\/a-2544-6325","type":"journal-article","created":{"date-parts":[[2025,2,21]],"date-time":"2025-02-21T19:29:56Z","timestamp":1740166196000},"page":"821-828","source":"Crossref","is-referenced-by-count":11,"title":["Impact of endoscopic ultrasound-guided biliary drainage on the management of difficult biliary cannulation in patients with distal malignant biliary obstruction"],"prefix":"10.1055","volume":"57","author":[{"given":"Marco","family":"Spadaccini","sequence":"additional","affiliation":[{"name":"Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy"},{"name":"Digestive Endoscopy Unit, IRCCS Humanitas Research Hospital, Rozzano, 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