EUS-guided transpapillary biliary drainage

Biliary access is sometimes not possible with ERCP. Traditionally these patients will require percutaneous transhepatic puncture for bile duct access and drainage. Recently, EUS-guided approaches are increasing employed for these patients and EUS-guided biliary drainage could be achieved with the transpapillary or transmural approaches. In this lecture, the advantages and disadvantages of the transpapillary approach would be discussed. In particular, the indications and procedural details of the rendezvous and antegrade approaches would be outlined.