First-line EUS-guided biliary drainage or ERCP in patients with biliary obstruction and in situ duodenal stent?

ERCP is the most commonly used technique for the palliation of malignant biliary obstruction.1,2 Success rates are high, ranging from 75% to 95%.3,4 Nevertheless, a pre-existing gastroduodenal stent (GDS) poses significant technical challenges for the endoscopist. The stent can be narrow and occluded as a result of tissue or tumor ingrowth, the stent interstices can make it difficult to pass a sphincterotome, and the stent can completely obscure the papilla, thereby preventing biliary access. In such cases, percutaneous transhepatic biliary drainage (PTBD) has traditionally been the mainstay of therapy.

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