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Algorithm for treatment of distal malignant biliary obstruction based on disease stage. Patients who are not candidates for ERCP with stent placement may undergo EUS-BD or percutaneous drainage. Adapted from Boulay BR, Parepally M. World J Gastroenterol 2014; 20: 9345-9353. SEMS: Self-expanding metallic stent; ERCP: Endoscopic retrograde cholangiography; EUS-BD: Endoscopic ultrasound-guided biliary drainage.
