Published online Jan 21, 2016. doi: 10.3748/wjg.v22.i3.1297
Peer-review started: August 11, 2015
First decision: September 11, 2015
Revised: September 28, 2015
Accepted: November 13, 2015
Article in press: November 13, 2015
Published online: January 21, 2016
Core tip: For inoperable malignant biliary obstruction, endoscopic ultrasonography (EUS)-guided biliary drainage (EUS-BD) should be selected before EUS-guided rendezvous technique or percutaneous transhepatic biliary drainage. EUS-BD is usually the first choice for patients having altered anatomy with malignant lower biliary obstruction. If both EUS-guided choledochoduodenostomy (EUS-CDS) and EUS-guided hepaticogastrostomy (EUS-HGS) are available, EUS-CDS should be selected. EUS-HGS has numerous potential complications compared to EUS-CDS. EUS-BD may well become a first-line biliary drainage procedure for malignant lower biliary obstruction in the near future.