ERCP intubation is often difficult in patients with biliary obstruction and changes in gastrointestinal structure, such as after Roux-en-Y or Billroth II surgery. EUS-BD is an alternative method. This meta-analysis should systematically compare the efficacy and safety of EUS-BD and ERCP in these patients. Studies were retrieved from PubMed, Embase, Web of Science, and the Cochrane Library from 2011 to 2026. Original studies comparing EUS-BD and ERCP in patients with biliary obstruction and a history of gastrointestinal reconstruction surgery were included. Two researchers independently carried out literature screening, data extraction, and quality evaluation. A meta-analysis was conducted using Review Manager. The main outcome measures are technical success rate, clinical success rate, adverse events, and procedure time. A total of 6 studies involving 572 patients (201 in the EUS-BD group and 371 in the ERCP group) were included in the technical success analysis. The meta-analysis demonstrated that the pooled technical success rate was 90.5% (182/201) for the EUS-BD group and 70.4% (261/371) for the ERCP group, yielding an odds ratio (OR) of 3.60 (95% CI: 2.12-6.13; p < 0.00001). For clinical success, the pooled odds ratio was 3.52 (95% CI: 2.07-5.98; p < 0.00001), demonstrating a statistically significant advantage over ERCP. In terms of safety, there was no difference in the overall incidence of adverse events between the two groups (25.9% vs. 20.5%; OR: 1.54, 95% CI: 0.97-2.44). In patients with biliary obstruction and surgically altered gastrointestinal anatomy, EUS-BD was associated with higher pooled technical and clinical success rates in available observational studies, along with shorter procedure time than ERCP. However, current evidence remains insufficient to establish a definitive difference in overall adverse events. EUS-BD represents a viable and highly effective alternative drainage modality for this challenging population, particularly when standard ERCP is anticipated to be technically demanding.

Signet-ring cell carcinoma is a poorly differentiated adenocarcinoma with a high degree of malignancy, which rarely occurs in hilar bile duct. As far as I know, this is the third signet-ring cell carcinoma of hilar cholangiocarcinoma found so far. We used endoscopic ultrasound（EUS） and per-oral cholangioscopy（POCPS） to make a definite diagnosis.

Endoscopic retrograde cholangiopancreatography (ERCP) remains the gold standard for Common bile duct (CBD) stone management, yet biliary cannulation challenges persist in some cases. There are limited data on primary Insulation-tipped (IT) knife precut for the biliary cannulation. Our aim was to investigate the efficacy and safety of IT nano knife-assisted primary precut in comparison to conventional cannulation for biliary access for the first time. This multicenter randomized controlled trial compared the efficacy and safety of primary IT knife nano-assisted precut sphincterotomy (group A) versus conventional cannulation (group B) in 340 patients with choledocholithiasis. Outcomes included initial/overall biliary cannulation success, procedural time, and adverse events (AEs). Group A demonstrated superior initial cannulation success compared to group B (85.9

Endoscopic ultrasound guided biliary drainage has become an effective drainage method for unresectable malignant obstructive jaundice, especially for patients after digestive tract reconstruction. We report a technique for assisting adequate guidewire biliary access during the drainage procedure.

Pancreatic duct leaks and fistulas are challenging complications of pancreatitis and pancreatic surgery. Although endoscopic retrograde pancreatic duct drainage (ERPD) is widely used, optimal drainage strategies remain incompletely defined. This study aimed to evaluate outcomes and identify predictors of clinical success of ERPD in patients with pancreatic leaks and fistulas. We conducted a multicenter retrospective study of consecutive patients with pancreatic duct leaks or fistulas refractory to conservative therapy who underwent ERPD at four tertiary centers between July 2007 and August 2023. Fistulas were classified using an endoscopy-oriented system. Drainage strategies were categorized as type A (stent placed across the leak), type B (stent placed adjacent to the leak), or type C (stent placed into the collection cavity). The primary outcome was clinical success within 3 months. Independent predictors of clinical success were assessed using multivariable logistic regression. A total of 106 patients were included. Technical success was achieved in 98.2

The incidence of hilar cholangiocarcinoma is (1-2) / 100,0001. Due to the high location of obstruction, the treatment of hilar cholangiocarcinoma is complicated, especially for patients with gastrointestinal surgery. The traditional ERCP technique is to find a way to place more stents to treat obstructive jaundice. When ERCP fails, (Percuteneous transhepatic cholangial drainage, PTCD) is often chosen, but the effect is not ideal. The reason is that patients do not want to carry a drainage tube, which affects the quality of life of patients. Secondly, PTCD technology is bile external drainage technology, which will affect the balance of water and electrolytes in the patient's body, and the patient's appetite will also decrease. Here, we provide a bridge technique of EUS-BD to solve the problem of simultaneous drainage of left liver and right liver with a stent, in order to provide a new treatment idea for endoscopists.

Pancreatic cutaneous fistula is a complex condition, making it challenging to achieve favorable outcomes with conservative medical treatment. Surgical interventions often entail surgical risks and postoperative complications. Here, we present a case involving endoscopically guided stent placement between the stomach and the fistula. By internalizing the fistula, patients can potentially remove the external drainage tube, offering a novel endoscopic treatment approach for such cases.

Biliary signet-ring cell carcinoma is a rare malignant tumor of the biliary tract. signet-ring cell carcinoma often occurs in the gastrointestinal tract. In this case, we can intuitively see the location, shape and scope of the tumor through endoscopic ultrasonography (EUS) combined with a peroral direct choledochoscope. Through the direct view biopsy technology, the tumor tissue in the biliary tract can be accurately sampled, providing a precise plan for the follow-up treatment of patients.

Multiple malignant biliary strictures are rare, and the application of multiple stents can achieve better drainage. EUS-guided biliary drainage (EUS-BD) can be offered as an alternative technique when ERCP unsuccessful. We applied Endoscopic ultrasonic guided antegrade stenting technique to treat a case of multiple biliary strictures following Roux-en-Y reconstruction.

When Endoscopic retrograde cholangiopancreatography (ERCP) fails in patients with obstructive jaundice, EUS-guided rendezvous technique (EUS-RV) becomes an alternative treatment. For the EUS-RV, we can puncture the intrahepatic bile duct (IHBD) and the extrahepatic bile duct (EHBD). Puncturing the EHBD needs through duodenum, the puncture site can be divided into via the proximal duodenum (D1) and via the second portion of the duodenum (D2). Puncturing the IHBD will difficult to perform at the patients whose IHBD is not dilated. For these patients, puncturing EHBD becomes an unavoidable choice. Generally, the closer the puncture point is to the duodenal papilla, the more difficult it is to implant the stent. Therefore, we innovatively adopted the method that concomitantly withdrawing the guidewire during stent deployment.

Background and Objectives:EUS-guided biliary drainage (EUS-BD) is an alternative to ERCP for patients with altered anatomy or duodenal obstruction. EUS-guided antegrade intervention (EUS-AG) offers physiological drainage with lower reintervention rates and higher stent patency. However, the technical complexity of EUS-AG limits its success rate, and factors associated with technical failure remain controversial. This study aimed to evaluate the learning curve for EUS-AG and identify predictors of technical failure. Patients and Methods:A cohort of 138 patients intended for EUS-AG between December 2019 and January 2025 was analyzed. CUSUM analysis was used to assess the learning curve based on procedure time. Technical failure was defined as failure to advance the antegrade guidewire across the duodenal papilla or bilioenteric anastomosis, failure of stent deployment, or failure to extract stones. Univariable and multivariable logistic regression analyses were performed to identify independent predictors of technical failure. Results:The overall technical success rate of EUS-AG was 78.2% (108/138). The CUSUM learning curve demonstrated a significant decrease in procedure time after 50 cases, indicating the transition to the proficiency phase. Multivariable analysis identified preproficiency phase (OR, 9.70; 95% CI, 2.91-32.30; P < 0.001), hilar bile duct obstruction (HBO) (OR, 14.36; 95% CI, 3.41-60.49; P < 0.001), and excessive bile duct dilation (EBD) (OR, 17.09; 95% CI, 4.80-60.89; P < 0.001) as independent predictors of technical failure. Conclusion:For endoscopists with proficient ERCP experience, the EUS-AG learning curve plateaued after approximately 50 cases. The preproficiency phase, HBO, and EBD were identified as independent predictors of technical failure.

It is not uncommon to encounter difficult cannulation during endoscopic retrograde cholangiopancreatography (ERCP), most of which can be performed by double-guide wire, pre-cut and other techniques. Endoscopic ultrasound-guided biliary drainage (EUS-BD) can be used as a remedial solution for ERCP failure. This article provides a very well experience in ERCP combine with EUS-RV technique in cases where the duodenal papilla is located above the medial diverticulum. At the same time, some skills of EUS-RV are provided for endoscopists.