Redefining endoluminal biliary drainage: Challenges and innovations in endosonography-guided techniques

Core Tip

Core Tip: The latest developments in endoscopic techniques have revolutionized the management of benign and malignant biliary obstructions. Studies have demonstrated that endosonography (EUS)-guided choledochoduodenostomy is a reliable alternative to endoscopic retrograde cholangiopancreatography and can be considered a primary drainage modality in centers with adequate expertise. In malignant hilar biliary obstructions, drainage of at least 50% of viable liver often requires a combination of different modalities. This manuscript examines novel multimodal approaches, including EUS-guided hepaticogastrostomy and hepaticoduodenostomy, as well as innovative techniques such as additional transhepatic bridging stents, which need further validation before broader clinical application. Current trends emphasize personalized treatment strategies, increasingly incorporating EUS-guided and hybrid approaches in biliary obstruction management.