Endoscopic ultrasound-guided biliary drainage as an alternative to percutaneous drainage and surgical bypass

Table 1 Advanvtage and disadvantage of puncturing sites

Route of access
Extrahepatic route	Intrahepatic route
Easy approach (especially for large-caliber CBD) The puncture site is close to the scope More difficult scope positioning to achieve desired direction from the punctured duct (rendezvous) Easy guidewire negotiation and neo-tract creation (EUS-BD) Difficult scope handling	The duct to be punctured is far from the scope Easier scope positioning to achieve desired direction from the punctured duct Easy scope handling Difficult guidewire negotiation and neo-tract creation Higher risk of bleeding Higher risk of bile leakage

CBD: Common bile duct; EUS-BD: Endoscopic ultrasound guided biliary drainage.