{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,10]],"date-time":"2026-06-10T11:42:06Z","timestamp":1781091726888,"version":"3.54.1"},"reference-count":101,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2026,2,28]],"date-time":"2026-02-28T00:00:00Z","timestamp":1772236800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Malignant biliary obstruction (MBO) represents a critical clinical challenge characterized by bile duct compromise leading to severe complications, including intractable jaundice, recurrent cholangitis, biliary cirrhosis, and hepatic failure. Classification into distal MBO (DMBO) and hilar MBO (HMBO) guides therapeutic decision-making, with the former predominantly caused by pancreatic head adenocarcinoma and extrahepatic cholangiocarcinoma, while perihilar cholangiocarcinoma represents the principal etiology of the latter. The high morbidity and mortality associated with MBO necessitate prompt, expert intervention. While endoscopic retrograde cholangiopancreatography (ERCP) with transpapillary biliary drainage (TBD) has traditionally served as the cornerstone of management for unresectable tumors, endoscopic ultrasound (EUS)-guided biliary drainage has emerged as a compelling alternative, particularly when conventional ERCP proves technically unsuccessful or anatomically unfeasible. This review comprehensively examines current endoscopic strategies for MBO, emphasizing the complementary roles of ERCP and EUS-based techniques. Optimal outcomes require intervention by experienced endoscopists at high-volume tertiary centers, with individualized treatment selection based on anatomical considerations, tumor characteristics, patient factors, and local expertise.<\/jats:p>","DOI":"10.3390\/diagnostics16050721","type":"journal-article","created":{"date-parts":[[2026,3,3]],"date-time":"2026-03-03T15:22:21Z","timestamp":1772551341000},"page":"721","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Role of Endoscopy in Malignant Biliary Obstruction"],"prefix":"10.3390","volume":"16","author":[{"given":"Ishaan","family":"Vohra","sequence":"first","affiliation":[{"name":"Department of Medicine, University of Illinois College of Medicine Peoria, Peoria, IL 61605, USA"},{"name":"Carle Methodist Healthcare System, Peoria, IL 61636, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Burraq","family":"Imran","sequence":"additional","affiliation":[{"name":"University of Exeter Medical School, Exeter EX1 2HZ, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zubair","family":"Khan","sequence":"additional","affiliation":[{"name":"AdventHealth, Orlando, FL 32803, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8608-7386","authenticated-orcid":false,"given":"Muhammad","family":"Hasan","sequence":"additional","affiliation":[{"name":"AdventHealth, Orlando, FL 32803, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,2,28]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"985","DOI":"10.3748\/wjg.v28.i10.985","article-title":"Malignant biliary obstruction due to metastatic non-hepato-pancreato-biliary cancer","volume":"28","author":"Okamoto","year":"2022","journal-title":"World J. Gastroenterol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"e796","DOI":"10.1097\/MPA.0000000000002504","article-title":"Comparison of Biliary Drainage Techniques for MBO: A Meta-Analysis","volume":"54","author":"Qiu","year":"2025","journal-title":"Pancreas"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"369","DOI":"10.1080\/00365521.2023.2282375","article-title":"ERCP for the initial management of malignant biliary obstruction\u2014Real world data on 596 procedures","volume":"59","author":"Mikalsen","year":"2024","journal-title":"Scand. J. Gastroenterol."},{"key":"ref_4","first-page":"33","article-title":"Malignant biliary obstruction: The current role of interventional radiology","volume":"29","author":"Tsetis","year":"2016","journal-title":"Ann. Gastroenterol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"4","DOI":"10.5005\/jp-journals-10071-24393","article-title":"Ultrasound-guided bedside percutaneous transhepatic biliary drainage in critically ill: A friend indeed","volume":"27","author":"Govil","year":"2023","journal-title":"Indian J. Crit. Care Med."},{"key":"ref_6","first-page":"291","article-title":"Endoscopic management of malignant biliary obstructions","volume":"37","author":"Binda","year":"2024","journal-title":"Ann. Gastroenterol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"581","DOI":"10.4253\/wjge.v14.i10.581","article-title":"Endoscopic palliation of malignant biliary obstruction","volume":"14","author":"Canakis","year":"2022","journal-title":"World J. Gastrointest. Endosc."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"415","DOI":"10.2147\/CEG.S195714","article-title":"Early diagnosis and management of malignant distal biliary obstruction: A review on current recommendations and guidelines","volume":"12","author":"Fernandez","year":"2019","journal-title":"Clin. Exp. Gastroenterol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"896","DOI":"10.1016\/j.gie.2021.12.032","article-title":"EUS-guided choledochoduodenostomy for malignant distal biliary obstruction after failed ERCP: A retrospective nationwide analysis","volume":"95","author":"Fugazza","year":"2022","journal-title":"Gastrointest. Endosc."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Pietrzak, J., and Przyby\u0142kowski, A. (2023). Endoscopic Treatment of Malignant Hilar Biliary Obstruction. Cancers, 15.","DOI":"10.3390\/cancers15245819"},{"key":"ref_11","first-page":"2747","article-title":"Unresectable perihilar cholangiocarcinoma: Multimodal palliative treatment","volume":"33","author":"Mosconi","year":"2013","journal-title":"Anticancer. Res."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"405","DOI":"10.14309\/ajg.0000000000002190","article-title":"ACG Clinical Guideline: Diagnosis and management of biliary strictures","volume":"118","author":"Elmunzer","year":"2023","journal-title":"Am. J. Gastroenterol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1055\/a-1717-1391","article-title":"Therapeutic endoscopic ultrasound: European Society of Gastrointestinal Endoscopy (ESGE) Guideline","volume":"54","author":"Bronswijk","year":"2022","journal-title":"Endoscopy"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"910","DOI":"10.1055\/a-0659-9864","article-title":"Endoscopic biliary stenting: Indications, choice of stents, and results: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline\u2014Updated October 2017","volume":"50","author":"Dumonceau","year":"2018","journal-title":"Endoscopy"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"503","DOI":"10.1055\/s-0034-1391231","article-title":"Prospective evaluation of ERCP performance: Results of a nationwide quality registry","volume":"47","author":"Ekkelenkamp","year":"2015","journal-title":"Endoscopy"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1004","DOI":"10.1055\/a-2580-1316","article-title":"Endoscopic ultrasound-guided choledochoduodenostomy results in fewer complications than percutaneous drainage following failed ERCP in malignant distal biliary obstruction","volume":"57","author":"Bogte","year":"2025","journal-title":"Endoscopy"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"35","DOI":"10.5348\/ijhpd-2015-32-CR-7","article-title":"Endoscopic palliative treatment vs surgical bypass in malignant low bile duct obstruction: A systematic review and meta-analysis","volume":"5","author":"Bustamante","year":"2015","journal-title":"Int. J. Hepatobiliary Pancreat. Dis."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"112","DOI":"10.1001\/jamaoncol.2015.3670","article-title":"Comparison of adverse events for endoscopic vs. percutaneous biliary drainage in the treatment of malignant biliary tract obstruction in an inpatient national cohort","volume":"2","author":"Inamdar","year":"2016","journal-title":"JAMA Oncol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"e35213","DOI":"10.1097\/MD.0000000000035213","article-title":"Percutaneous transhepatic biliary drainage (PTBD) in patients with biliary leakage: Technical and clinical outcomes","volume":"102","author":"Deniz","year":"2023","journal-title":"Medicine"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"764","DOI":"10.1097\/MCG.0000000000000275","article-title":"Drainage-related complications in percutaneous transhepatic biliary drainage: An analysis over 10 years","volume":"49","author":"Nennstiel","year":"2015","journal-title":"J. Clin. Gastroenterol."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Park, C.H., Park, S.W., Jung, J.H., Jung, E.S., Kim, J.H., and Park, D.H. (2021). Comparative Efficacy of Various Stents for Palliation in Patients with Malignant Extrahepatic Biliary Obstruction: A Systematic Review and Network Meta-Analysis. J. Pers. Med., 11.","DOI":"10.3390\/jpm11020086"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"444","DOI":"10.1016\/0002-9610(87)90787-2","article-title":"Endoscopic biliary stents and obstructive jaundice","volume":"153","author":"Walta","year":"1987","journal-title":"Am. J. Surg."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"260","DOI":"10.1038\/ajg.2016.512","article-title":"Plastic vs. self-expandable metal stents for palliation in malignant biliary obstruction: A series of meta-analyses","volume":"112","author":"Almadi","year":"2017","journal-title":"Am. J. Gastroenterol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"259","DOI":"10.1111\/den.12379","article-title":"TOKYO criteria 2014 for transpapillary biliary stenting","volume":"27","author":"Isayama","year":"2015","journal-title":"Dig. Endosc."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"256","DOI":"10.1016\/j.gie.2015.03.1980","article-title":"Self-expandable metal stents versus plastic stents for malignant biliary obstruction: A meta-analysis","volume":"82","author":"Sawas","year":"2015","journal-title":"Gastrointest. Endosc."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"130","DOI":"10.1053\/j.gastro.2015.03.012","article-title":"Cost efficacy of metal stents for palliation of extrahepatic bile duct obstruction in a randomized controlled trial","volume":"149","author":"Walter","year":"2015","journal-title":"Gastroenterology"},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Bor, R., F\u00e1bi\u00e1n, A., Sz\u0171cs, M., B\u00e1lint, A., Rutka, M., T\u00f3th, T., Czak\u00f3, L., Farkas, K., Buz\u00e1s, N., and Milassin, \u00c1. (2023). Comparison of therapeutic efficacy and treatment costs of self-expandable metal stents and plastic stents for management of malignant biliary obstruction. BMC Gastroenterol., 23.","DOI":"10.1186\/s12876-023-02668-9"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"817","DOI":"10.5946\/ce.2025.045","article-title":"Self-expandable metal vs. plastic stents for preoperative biliary drainage in patients receiving neoadjuvant chemotherapy","volume":"58","author":"Tamura","year":"2025","journal-title":"Clin. Endosc."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1319","DOI":"10.1245\/s10434-023-14523-y","article-title":"Comparison between plastic and metallic biliary stent placement for preoperative patients with pancreatic head cancer: A systematic review and meta-analysis","volume":"31","author":"Endo","year":"2024","journal-title":"Ann. Surg. Oncol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"748","DOI":"10.1016\/j.gie.2010.05.023","article-title":"Risk of post-ERCP pancreatitis with placement of self-expandable metallic stents","volume":"72","author":"Kumar","year":"2010","journal-title":"Gastrointest. Endosc."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1016\/j.gie.2023.08.004","article-title":"Adverse events of self-expandable metal stent placement for malignant distal biliary obstruction: A large multicenter study","volume":"99","author":"Tamura","year":"2024","journal-title":"Gastrointest. Endosc."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"631","DOI":"10.1055\/s-0043-125062","article-title":"Covered vs. uncovered self-expandable metal stents for malignant distal biliary strictures: A systematic review and meta-analysis","volume":"50","author":"Tringali","year":"2018","journal-title":"Endoscopy"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"314","DOI":"10.1016\/j.gie.2023.10.023","article-title":"Fully covered versus partially covered self-expandable metal stents for palliation of distal malignant biliary obstruction: A systematic review and meta-analysis","volume":"99","author":"Vanella","year":"2024","journal-title":"Gastrointest. Endosc."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"791","DOI":"10.31557\/APJCP.2023.24.3.791","article-title":"A Bayesian network meta-analysis comparing biliary stent types\u2019 outcome and complications in unresectable malignant biliary obstructions","volume":"24","author":"Aryanti","year":"2023","journal-title":"Asian Pac. J. Cancer Prev."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"312","DOI":"10.1016\/j.gie.2013.02.032","article-title":"Comparison of the utility of covered metal stents versus uncovered metal stents in the management of malignant biliary strictures in 749 patients","volume":"78","author":"Lee","year":"2013","journal-title":"Gastrointest. Endosc."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"729","DOI":"10.1136\/gut.2003.018945","article-title":"A prospective randomised study of \u201ccovered\u201d versus \u201cuncovered\u201d diamond stents for the management of distal malignant biliary obstruction","volume":"53","author":"Isayama","year":"2004","journal-title":"Gut"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1713","DOI":"10.1038\/ajg.2013.305","article-title":"Covered self-expandable metal stents with an anti-migration system improve patency duration without increased complications compared with uncovered stents for distal biliary obstruction caused by pancreatic carcinoma: A randomized multicenter trial","volume":"108","author":"Kitano","year":"2013","journal-title":"Am. J. Gastroenterol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"577","DOI":"10.1016\/j.gie.2023.05.047","article-title":"Uncovered versus fully covered self-expandable metal stents for the management of distal malignant biliary obstruction","volume":"98","author":"Ghazi","year":"2023","journal-title":"Gastrointest. Endosc."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"26317745251376845","DOI":"10.1177\/26317745251376845","article-title":"Comparison of fully covered versus uncovered self-expandable metallic stents in treating inoperable malignant distal biliary obstruction: A retrospective study","volume":"18","author":"Zhang","year":"2025","journal-title":"Ther. Adv. Gastrointest. Endosc."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"938","DOI":"10.1111\/den.14260","article-title":"Covered versus uncovered metal stent for endoscopic drainage of a malignant distal biliary obstruction: Meta-analysis","volume":"34","author":"Yamashita","year":"2022","journal-title":"Dig. Endosc."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"220","DOI":"10.1016\/j.gie.2025.06.044","article-title":"Postprocedural cholecystitis following covered self-expandable metal stent placement in patients with distal malignant biliary obstruction: A systematic review and meta-analysis","volume":"103","author":"Lopimpisuth","year":"2025","journal-title":"Gastrointest. Endosc."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"939","DOI":"10.1016\/j.surg.2016.11.001","article-title":"Preoperative biliary stenting versus operation first in jaundiced patients due to malignant lesions in the pancreatic head: A meta-analysis of current literature","volume":"161","author":"Scheufele","year":"2017","journal-title":"Surgery"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1056\/NEJMoa0903230","article-title":"Preoperative biliary drainage for cancer of the head of the pancreas","volume":"362","author":"Rauws","year":"2010","journal-title":"N. Engl. J. Med."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"e182","DOI":"10.1016\/j.cgh.2020.12.020","article-title":"Superiority of self-expandable metallic stents over plastic stents in treatment of malignant distal biliary strictures","volume":"20","author":"Jang","year":"2022","journal-title":"Clin. Gastroenterol. Hepatol."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1016\/j.gie.2012.02.041","article-title":"Efficacy and safety of self-expandable metal stents for biliary decompression in patients receiving neoadjuvant therapy for pancreatic cancer: A prospective study","volume":"76","author":"Aadam","year":"2012","journal-title":"Gastrointest. Endosc."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"1744","DOI":"10.1007\/s10620-012-2482-z","article-title":"Self-expanding metal stents (SEMS) for preoperative biliary decompression in patients with resectable and borderline-resectable pancreatic cancer: Outcomes in 241 patients","volume":"58","author":"Siddiqui","year":"2013","journal-title":"Dig. Dis. Sci."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"E714","DOI":"10.1055\/a-0599-6190","article-title":"Safety and efficacy of self-expanding metal stents for biliary drainage in patients receiving neoadjuvant therapy for pancreatic cancer","volume":"6","author":"Ballard","year":"2018","journal-title":"Endosc. Int. Open"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"691","DOI":"10.1111\/hpb.12450","article-title":"Hilar cholangiocarcinoma: Expert consensus statement","volume":"17","author":"Mansour","year":"2015","journal-title":"HPB"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"120","DOI":"10.18528\/ijgii210035","article-title":"Proper management of inoperable malignant hilar biliary obstruction","volume":"10","author":"Lee","year":"2021","journal-title":"Int. J. Gastrointest. Interv."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"593","DOI":"10.1111\/jgh.12128","article-title":"Asia\u2013Pacific consensus recommendations for endoscopic and interventional management of hilar cholangiocarcinoma","volume":"28","author":"Rerknimitr","year":"2013","journal-title":"J. Gastroenterol. Hepatol."},{"key":"ref_51","first-page":"347","article-title":"The role of endoscopy in malignant hilar obstruction","volume":"36","author":"Dhar","year":"2023","journal-title":"Ann. Gastroenterol."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1016\/j.gie.2008.04.005","article-title":"Palliative treatment with self-expandable metallic stents in patients with advanced type III or IV hilar cholangiocarcinoma: A percutaneous versus endoscopic approach","volume":"69","author":"Paik","year":"2009","journal-title":"Gastrointest. Endosc."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"222","DOI":"10.1016\/j.gie.2020.12.035","article-title":"ASGE guideline on the role of endoscopy in the management of malignant hilar obstruction","volume":"94","author":"Qumseya","year":"2021","journal-title":"Gastrointest. Endosc."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"728","DOI":"10.1016\/j.gie.2010.06.040","article-title":"Prediction of drainage effectiveness during endoscopic stenting of malignant hilar strictures: The role of liver volume assessment","volume":"72","author":"Vienne","year":"2010","journal-title":"Gastrointest. Endosc."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"222","DOI":"10.1016\/j.gie.2019.03.011","article-title":"Prospective comparison of endoscopic bilateral stent-in-stent versus stent-by-stent deployment for inoperable advanced malignant hilar biliary stricture","volume":"90","author":"Lee","year":"2019","journal-title":"Gastrointest. Endosc."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"547","DOI":"10.1067\/mge.2001.113381","article-title":"Unilateral versus bilateral endoscopic hepatic duct drainage in patients with malignant hilar biliary obstruction: Results of a prospective, randomized, and controlled study","volume":"53","author":"Galloro","year":"2001","journal-title":"Gastrointest. Endosc."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"5210","DOI":"10.3748\/wjg.v25.i34.5210","article-title":"Bilateral vs. unilateral placement of metal stents for inoperable high-grade hilar biliary strictures: A systemic review and meta-analysis","volume":"25","author":"Ashat","year":"2019","journal-title":"World J. Gastroenterol."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"350","DOI":"10.1016\/j.gie.2024.09.037","article-title":"Efficacy and safety of covered self-expandable metal stents for malignant hilar biliary obstruction: Systematic review and meta-analysis","volume":"101","author":"Chung","year":"2025","journal-title":"Gastrointest. Endosc."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"279","DOI":"10.5114\/wiitm.2021.112477","article-title":"Side-by-side versus stent-in-stent bilateral stenting for malignant hilar biliary obstruction: A meta-analysis","volume":"17","author":"Chen","year":"2022","journal-title":"Videosurgery Other Miniinvasive Tech."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"e70075","DOI":"10.1002\/deo2.70075","article-title":"Side-by-side versus stent-in-stent technique for stent deployment during systemic chemotherapy in biliary tract cancer patients","volume":"5","author":"Imamura","year":"2025","journal-title":"DEN Open"},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"321","DOI":"10.1016\/j.jamcollsurg.2016.03.035","article-title":"Postoperative mortality after liver resection for perihilar cholangiocarcinoma","volume":"223","author":"Wiggers","year":"2016","journal-title":"J. Am. Coll. Surg."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"1628","DOI":"10.1016\/j.ejso.2017.04.001","article-title":"Preoperative biliary drainage in hilar cholangiocarcinoma: Systematic review and meta-analysis","volume":"43","author":"Celotti","year":"2017","journal-title":"Eur. J. Surg. Oncol."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"400","DOI":"10.1016\/j.hpb.2016.03.002","article-title":"Percutaneous vs. endoscopic pre-operative biliary drainage in hilar cholangiocarcinoma","volume":"18","author":"Hameed","year":"2016","journal-title":"HPB"},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"576","DOI":"10.1016\/j.jvir.2016.12.1218","article-title":"Preoperative biliary drainage in patients with resectable perihilar cholangiocarcinoma","volume":"28","author":"Menahem","year":"2017","journal-title":"J. Vasc. Interv. Radiol."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"681","DOI":"10.1016\/S2468-1253(18)30234-6","article-title":"Endoscopic versus percutaneous biliary drainage in patients with resectable perihilar cholangiocarcinoma","volume":"3","author":"Coelen","year":"2018","journal-title":"Lancet Gastroenterol. Hepatol."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"242","DOI":"10.1007\/s00535-010-0298-1","article-title":"Endoscopic nasobiliary drainage is the most suitable preoperative biliary drainage method","volume":"46","author":"Kawakami","year":"2011","journal-title":"J. Gastroenterol."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"68","DOI":"10.4253\/wjge.v6.i3.68","article-title":"Preoperative biliary drainage in hilar cholangiocarcinoma: When and how?","volume":"6","author":"Paik","year":"2014","journal-title":"World J. Gastrointest. Endosc."},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"395","DOI":"10.1016\/j.gie.2024.04.019","article-title":"EUS- versus ERCP-guided biliary drainage for malignant biliary obstruction","volume":"100","author":"Barbosa","year":"2024","journal-title":"Gastrointest. Endosc."},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"987","DOI":"10.1038\/s41395-018-0122-8","article-title":"EUS-Guided Biliary Drainage Versus ERCP for the Primary Palliation of Malignant Biliary Obstruction: A Multicenter Randomized Clinical Trial","volume":"113","author":"Paik","year":"2018","journal-title":"Am. J. Gastroenterol."},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"533","DOI":"10.5946\/ce.2024.183","article-title":"Efficacy of endoscopic ultrasound-guided biliary drainage of malignant biliary obstruction: A systematic review and meta-analysis of randomized controlled trials","volume":"58","author":"Zafar","year":"2025","journal-title":"Clin. Endosc."},{"key":"ref_71","doi-asserted-by":"crossref","unstructured":"Lambin, T., Leblanc, S., and Napol\u00e9on, B. (2025). Advances in EUS-Guided Biliary Drainage for the Management of Pancreatic Cancer. Cancers, 17.","DOI":"10.3390\/cancers17213428"},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"1037","DOI":"10.1055\/a-1324-7919","article-title":"Efficacy of Lumen-Apposing Metal Stents or Self-Expandable Metal Stents for Endoscopic Ultrasound-Guided Choledochoduodenostomy","volume":"53","author":"Amato","year":"2021","journal-title":"Endoscopy"},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"2004","DOI":"10.1016\/j.dld.2024.08.053","article-title":"Primary drainage of distal malignant biliary obstruction: A comparative network meta-analysis","volume":"56","author":"Lauri","year":"2024","journal-title":"Dig. Liver Dis."},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1097\/MCG.0000000000000948","article-title":"EUS-Guided Choledochoduodenostomy Versus Hepaticogastrostomy","volume":"52","author":"Uemura","year":"2018","journal-title":"J. Clin. Gastroenterol."},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"2866","DOI":"10.1007\/s00464-020-07484-w","article-title":"Effectiveness and Safety of EUS-Guided Choledochoduodenostomy Using Lumen-Apposing Metal Stents","volume":"34","author":"Krishnamoorthi","year":"2020","journal-title":"Surg. Endosc."},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"1769","DOI":"10.1111\/jgh.16614","article-title":"Adverse Events in Endoscopic Ultrasound-Guided Choledochoduodenostomy with Lumen-Apposing Metal Stents","volume":"39","author":"Li","year":"2024","journal-title":"J. Gastroenterol. Hepatol."},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"E456","DOI":"10.1055\/a-2271-2145","article-title":"Outcomes Predictors in Endoscopic Ultrasound-Guided Choledochoduodenostomy with Lumen-Apposing Metal Stent","volume":"12","author":"Fugazza","year":"2024","journal-title":"Endosc. Int. Open"},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"955","DOI":"10.1055\/a-2340-0697","article-title":"Endoscopic Ultrasound- versus ERCP-Guided Primary Drainage of Inoperable Malignant Distal Biliary Obstruction","volume":"56","author":"Khoury","year":"2024","journal-title":"Endoscopy"},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"e8","DOI":"10.1002\/deo2.8","article-title":"Technical Tips and Recent Development of Endoscopic Ultrasound-Guided Choledochoduodenostomy","volume":"1","author":"Ogura","year":"2021","journal-title":"DEN Open"},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"243","DOI":"10.1097\/MCG.0000000000001167","article-title":"Efficacy and safety of endoscopic ultrasound-guided choledochoduodenostomy","volume":"53","author":"Mohan","year":"2019","journal-title":"J. Clin. Gastroenterol."},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"990","DOI":"10.1055\/a-2541-2973","article-title":"Technical failure of endoscopic ultrasound-guided choledochoduodenostomy","volume":"57","author":"Beunon","year":"2025","journal-title":"Endoscopy"},{"key":"ref_82","doi-asserted-by":"crossref","first-page":"330","DOI":"10.1055\/a-2463-1601","article-title":"Stent misdeployment and factors associated with failure in endoscopic ultrasound-guided choledochoduodenostomy","volume":"57","author":"Chen","year":"2025","journal-title":"Endoscopy"},{"key":"ref_83","doi-asserted-by":"crossref","first-page":"377","DOI":"10.1111\/den.14445","article-title":"Classification, risk factors, and management of lumen apposing metal stent dysfunction","volume":"35","author":"Vanella","year":"2023","journal-title":"Dig. Endosc."},{"key":"ref_84","doi-asserted-by":"crossref","first-page":"898","DOI":"10.1055\/s-2001-17324","article-title":"Endoscopic ultrasound-guided bilioduodenal anastomosis","volume":"33","author":"Giovannini","year":"2001","journal-title":"Endoscopy"},{"key":"ref_85","doi-asserted-by":"crossref","unstructured":"Mazza, S., Masciangelo, G., Mauro, A., Scalvini, D., Viera, F.T., Bardone, M., Veronese, L., Rovedatti, L., Agazzi, S., and Strada, E. (2024). Endoscopic Ultrasound-Guided Hepaticogastrostomy in Malignant Biliary Obstruction. Diagnostics, 14.","DOI":"10.3390\/diagnostics14232644"},{"key":"ref_86","doi-asserted-by":"crossref","first-page":"310","DOI":"10.1055\/a-1738-6780","article-title":"Therapeutic Endoscopic Ultrasound: ESGE Technical Review","volume":"54","author":"Bronswijk","year":"2022","journal-title":"Endoscopy"},{"key":"ref_87","doi-asserted-by":"crossref","first-page":"e70037","DOI":"10.1002\/jgh3.70037","article-title":"Efficacy and safety of EUS hepaticogastrostomy versus choledochoduodenostomy","volume":"8","author":"Rizqiansyah","year":"2024","journal-title":"JGH Open"},{"key":"ref_88","doi-asserted-by":"crossref","first-page":"1044","DOI":"10.1002\/ueg2.12552","article-title":"Long-term outcomes of endoscopic ultrasound-guided hepaticogastrostomy","volume":"12","author":"Hedjoudje","year":"2024","journal-title":"United Eur. Gastroenterol. J."},{"key":"ref_89","doi-asserted-by":"crossref","first-page":"2416607","DOI":"10.1080\/07853890.2024.2416607","article-title":"Endoscopic ultrasound-guided biliary rendezvous after failed cannulation","volume":"56","author":"Gornals","year":"2024","journal-title":"Ann. Med."},{"key":"ref_90","doi-asserted-by":"crossref","first-page":"264","DOI":"10.1111\/den.14393","article-title":"Current status of endoscopic ultrasound-guided antegrade intervention","volume":"35","author":"Iwashita","year":"2023","journal-title":"Dig. Endosc."},{"key":"ref_91","doi-asserted-by":"crossref","unstructured":"Khoury, T., Farraj, M., Sbeit, W., Fusaroli, P., Barbara, G., Binda, C., Fabbri, C., Basheer, M., Leblanc, S., and Fumex, F. (2025). EUS-Guided Gallbladder Drainage of Inoperable Malignant Distal Biliary Obstruction. Cancers, 17.","DOI":"10.3390\/cancers17121983"},{"key":"ref_92","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1097\/eus.0000000000000108","article-title":"EUS-Guided Gallbladder Drainage as a Rescue in Distal Malignant Biliary Obstruction","volume":"14","author":"Rizzo","year":"2025","journal-title":"Endosc. Ultrasound"},{"key":"ref_93","doi-asserted-by":"crossref","first-page":"8","DOI":"10.4103\/EUS-D-21-00206","article-title":"Efficacy and Safety of EUS-Guided Gallbladder Drainage for Rescue Treatment","volume":"12","author":"Kamal","year":"2022","journal-title":"Endosc. Ultrasound"},{"key":"ref_94","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1111\/den.14750","article-title":"Effectiveness of endoscopic ultrasound-guided choledochoduodenostomy vs. EUS-guided gallbladder drainage","volume":"37","author":"Debourdeau","year":"2025","journal-title":"Dig. Endosc."},{"key":"ref_95","doi-asserted-by":"crossref","first-page":"250926","DOI":"10.1016\/j.tige.2025.250926","article-title":"Endoscopic Ultrasound-Guided Gastroenterostomy vs. Enteral Stenting for Malignant Gastric Outlet Obstruction: A Systematic Review and Meta-analysis","volume":"27","author":"Fernandes","year":"2025","journal-title":"Tech. Innov. Gastrointest. Endosc."},{"key":"ref_96","doi-asserted-by":"crossref","first-page":"1065","DOI":"10.1016\/S2468-1253(25)00209-2","article-title":"Endoscopic versus surgical gastroenterostomy for palliation of malignant gastric outlet obstruction (ENDURO)","volume":"10","author":"Kastelijn","year":"2025","journal-title":"Lancet Gastroenterol. Hepatol."},{"key":"ref_97","doi-asserted-by":"crossref","first-page":"13715","DOI":"10.1038\/s41598-024-64734-w","article-title":"Risk prediction of cholangitis after stent implantation based on machine learning","volume":"14","author":"Zhao","year":"2024","journal-title":"Sci. Rep."},{"key":"ref_98","first-page":"237","article-title":"Development and application of an early warning model for predicting early mortality","volume":"29","author":"Ma","year":"2025","journal-title":"Oncol. Lett."},{"key":"ref_99","doi-asserted-by":"crossref","first-page":"5107","DOI":"10.1007\/s00464-025-11937-5","article-title":"Machine learning-based prediction model for post-ERCP cholangitis","volume":"39","author":"Jin","year":"2025","journal-title":"Surg. Endosc."},{"key":"ref_100","doi-asserted-by":"crossref","first-page":"166","DOI":"10.1055\/a-2481-7048","article-title":"Diagnostic work-up of bile duct strictures: European Society of Gastrointestinal Endoscopy (ESGE) Guideline","volume":"57","author":"Facciorusso","year":"2025","journal-title":"Endoscopy"},{"key":"ref_101","doi-asserted-by":"crossref","first-page":"1029","DOI":"10.1111\/den.15060","article-title":"World Endoscopy Organization guidelines on endoscopic retrograde cholangiopancreatography biliary cannulation and sphincterotomy techniques","volume":"37","author":"Aabakken","year":"2025","journal-title":"Dig. Endosc."}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/16\/5\/721\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,3]],"date-time":"2026-03-03T15:44:28Z","timestamp":1772552668000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/16\/5\/721"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,28]]},"references-count":101,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2026,3]]}},"alternative-id":["diagnostics16050721"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics16050721","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,28]]}}}