ABSTRACT
Endoscopic ultrasound-guided biliary drainage (EUS-BD) is emerging as a safe and effective alternative for endoscopic BD. The advantage of multiple access points from stomach and duodenum allows EUS-BD in patients with altered surgical anatomy and duodenal stenosis. EUS-BD is also useful in patients with failed endoscopic retrograde cholangiopancreatography or difficult biliary cannulation. Depending on the access and exit route of the stent, a variety of EUS-BD procedures have been described. Trans-papillary as well as trans-luminal stent placements are possible with EUS-BD. Recent studies have shown a clinical success rate in excess of 90% and complication rates of < 15%. Prospective studies are needed to know the long-term results and relative efficacy of this technique.