Table 1.

Take‐home message

EUS‐BD yields the highest technical success when compared to ERCP in the majority of patients with MDBO and with a comparable safety profile. The most common adverse event of ERCP, postprocedure pancreatitis, is minimal with EUS‐BD. While it is obvious that EUS‐BD can be performed effectively and efficiently in expert hands, further procedural standardization and technological refinements are required to facilitate widespread adoption. We propose an algorithm for futuristic adoption of EUS‐BD. Training in EUS‐BD is of paramount importance, given the promising future potential for this treatment approach. Development of a curriculum that incorporates training in models, observation at expert centers, gaining proficiency in individual procedural components, and hands‐on training with proctoring of complex cases is required to advance the practice.

ERCP, endoscopic retrograde cholangiopancreatography; EUS, endoscopic ultrasound; EUS‐BD, endoscopic ultrasonography‐guided biliary drainage; MDBO, malignant distal biliary obstruction.