《Table 1 Current indications for endoscopic ultrasonography-guided biliary drainage after failure of

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《Comprehensive review on EUS-guided biliary drainage》

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GI:Gastrointestinal.

Endoscopic retrograde cholangiopancreatography（ERCP）with stent placement represents standard treatment for the management of benign and malignant biliary obstructions.Approximately 500000 ERCPs are performed annually in the United States alone with a failure rate that varies between 5%and 7%[1].ERCP-guided biliary drainage is performed by direct cannulation of the papilla under endoscopic vision via the duodenoscope with the assistance of radiological cholangiography.Once the biliary tract has been reached，the biliary drainage can be obtained with different devices and technique（with stent positioning）depending on the underlying disease.In light of this，the papilla must necessarily be endoscopically reachable.Therefore，reasons for failure depend mainly on whether the papilla is endoscopically accessible or not.In the first case，ampullary pathology，periampullary diverticulum，and ampullary neoplastic infiltration can cause failure.In the second case，benign（peptic stenosis）and malignant duodenal stenosis or postsurgical anatomy such as a gastrointestinal bariatric bypass，a Roux-en Y gastric bypass or a Billroth II gastroenterostomy may prevent the access to the papilla causing unsuccessful procedures（Table 1）.