Antonini F, Galasso D, Giovannini M. Endoscopic management of malignant hilar biliary obstruction: The evolving role of endoscopic ultrasound-guided biliary drainage. World J Gastrointest Endosc 2026; 18(5): 119500 [DOI: 10.4253/wjge.v18.i5.119500]
Corresponding Author of This Article
Filippo Antonini, Chief Physician, Department of Gastroenterology and Interventional Endoscopy Unit, C. e G. Mazzoni Hospital, Via degli Iris 1, Ascoli Piceno 63100, Marche, Italy. filippore@yahoo.it
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Gastroenterology & Hepatology
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Editorial
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May 16, 2026 (publication date) through May 12, 2026
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Publication Name
World Journal of Gastrointestinal Endoscopy
ISSN
1948-5190
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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
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Antonini F, Galasso D, Giovannini M. Endoscopic management of malignant hilar biliary obstruction: The evolving role of endoscopic ultrasound-guided biliary drainage. World J Gastrointest Endosc 2026; 18(5): 119500 [DOI: 10.4253/wjge.v18.i5.119500]
World J Gastrointest Endosc. May 16, 2026; 18(5): 119500 Published online May 16, 2026. doi: 10.4253/wjge.v18.i5.119500
Endoscopic management of malignant hilar biliary obstruction: The evolving role of endoscopic ultrasound-guided biliary drainage
Filippo Antonini, Domenico Galasso, Marc Giovannini
Filippo Antonini, Department of Gastroenterology and Interventional Endoscopy Unit, C. e G. Mazzoni Hospital, Ascoli Piceno 63100, Marche, Italy
Domenico Galasso, Department of Gastroenterology and Hepatology Service, Centre Hospitalier Universitaire Vaudois, Lausanne 1011, Vaud, Switzerland
Marc Giovannini, Interventional Gastroenterology, IRCAD France, Strasbourg 67100, France
Author contributions: Antonini F wrote the original draft and contributed to conceptualization and reviewing; Galasso D and Giovannini M contributed to reviewing and editing; and all authors have read and approved the final version of the manuscript.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Corresponding author: Filippo Antonini, Chief Physician, Department of Gastroenterology and Interventional Endoscopy Unit, C. e G. Mazzoni Hospital, Via degli Iris 1, Ascoli Piceno 63100, Marche, Italy. filippore@yahoo.it
Received: January 29, 2026 Revised: February 3, 2026 Accepted: March 10, 2026 Published online: May 16, 2026 Processing time: 103 Days and 7.3 Hours
Abstract
In this editorial, we comment on the article by Pietrzak et al published in the recent issue of the World Journal of Gastrointestinal Endoscopy. Malignant hilar biliary obstruction remains a formidable challenge for endoscopists. While endoscopic retrograde cholangiopancreatography continues to represent the cornerstone of biliary drainage, malignant hilar biliary obstruction often requires a multimodal approach that incorporates percutaneous-guided techniques, either as complementary or salvage strategies. Emerging evidence also supports the integration of endoscopic ultrasound-guided biliary drainage as a planned adjunct in selected cases to optimize biliary drainage, reduce the need for re-intervention, and improve clinical outcomes. In this editorial, we review current guideline recommendations and key technical considerations, emphasizing the role of endoscopic ultrasound-guided biliary drainage in expert hands for patients with complex hilar anatomy or incomplete drainage after endoscopic retrograde cholangiopancreatography.
Core Tip: Malignant hilar biliary obstruction often requires more than endoscopic retrograde cholangiopancreatography (ERCP) to achieve adequate biliary drainage. Endoscopic ultrasound-guided biliary drainage is an emerging adjunct for patients in whom ERCP is insufficient or technically challenging. As part of a multimodal strategy, including ERCP and percutaneous drainage, endoscopic ultrasound-guided biliary drainage can improve drainage, reduce re-interventions, and enhance outcomes. Expanding expertise and specialized centers is essential to define its role in malignant hilar biliary obstruction management.
