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Technical and clinical success rates were 92.4 % and 93.6 %, respectively. 103 self-expandable metallic stents (SEMS), 2 lumen-apposing metal stents (LAMS), and 22 plastic stents were used.<\/jats:p><jats:p>The successful access routes to the bile duct system were trans-gastric (n=69), trans-jejunal (n=39), and trans-esophageal (n=2).<\/jats:p><jats:p>Adverse events (AE) occurred in 19.5 % and re-interventions were necessary in 27.9 % of cases. The median post-interventional survival time was 85 (95% CI: 45\u2013256) days. The following parameters were associated with a significantly shorter survival time: CRP &gt; 50 mg\/L, bilirubin serum level &gt; 200 \u00b5mol\/L, high tumor burden, Karnofsky index &lt; 80, and manifest malnutrition status.<\/jats:p><jats:p>EUS-BD in malignant biliary obstruction is a safe and effective method, even with surgically altered anatomy of the upper GI tract, in experienced hands of interventional EUS.<\/jats:p>","DOI":"10.1055\/a-2644-0656","type":"journal-article","created":{"date-parts":[[2025,10,8]],"date-time":"2025-10-08T23:02:04Z","timestamp":1759964524000},"page":"1025-1036","source":"Crossref","is-referenced-by-count":1,"title":["Endoscopic Ultrasound-Guided Biliary Drainage (EUS-BD) for malignant biliary obstruction after failed endoscopic retrograde cholangiography (ERC) in patients with surgically altered anatomy"],"prefix":"10.1055","volume":"63","author":[{"given":"Sabine","family":"Thuemer","sequence":"additional","affiliation":[{"name":"Dept. of 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