Primary EUS-guided drainage for malignant distal biliary obstruction: not yet prime time!

Endoscopic drainage has virtually replaced surgery for biliary obstruction, irrespective of a benign or a malignant cause. Compared with surgery, ERCP for palliative drainage of malignant biliary obstruction is less expensive, is associated with reduced morbidity, and provides a better quality of life.1-3 When compared with percutaneous transhepatic biliary drainage (PTBD), ERCP is associated with lower rates of adverse events and a better quality of life.4 Therefore, ERCP has been traditionally preferred over surgery and PTBD in cases with malignant biliary obstruction.

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