《Table 2 Algorithms for guidance endoscopic ultrasonography-guided biliary drainage》

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《Comprehensive review on EUS-guided biliary drainage》

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PS:Prospective study；EUS-RV:Endoscopic ultrasonography-guided rendez；EUS-AS:Endoscopic ultrasonography-guided antegrade stent placement；EUS-BD:Endoscopic ultrasonography-guided biliary drainage；IHBT:Intrahepatic biliary tree；IHa:Intrahepatic approach；EHa:

PTBD represents a rescue procedure for ERCP failure.The technical success rate of PTBD is over 95%with a 33%or higher overall adverse event rate including bleeding，infection，dislodgement，biliary leak，and tract seeding[2].Moreover，this technique can be uncomfortable for the patient due to an external drainage catheter and is contraindicated with ascites or multiple liver metastasis.EUS-BD has become an evolving alternative to PTBD with a better clinical success rate（OR:0.45），fewer adverse events（OR:0.23），and fewer reinterventions（OR:0.13）[16]（Tables 3 and 4）.EUS biliary drainage can be achieved by puncturing the intrahepatic duct in the III segment（intrahepatic approach）and inserting an HGA stent，advancing a guidewire across the stricture and the papilla to complete an antegrade stent placement，or by puncturing the common bile duct，or the gallbladder（extrahepatic approach）with CDS or GBD（Figure 2）.When the papilla is accessible，puncturing the biliary tree（intrahepatic or extrahepatic）and inserting the guidewire into the small intestine to cannulate with the rendez-vous technique（EUS-RV）represents the most appropriate and safe route.