Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.
World J Gastrointest Endosc. May 16, 2026; 18(5): 119500
Published online May 16, 2026. doi: 10.4253/wjge.v18.i5.119500
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, 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
Revised: February 3, 2026
Accepted: March 10, 2026
Published online: May 16, 2026
Processing time: 103 Days and 7.3 Hours
Core Tip
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.