Illustration of biliary drainage procedures EUS and ERCP.

EUS vs. ERCP: Choosing the Right Drainage Method for Biliary Obstruction

Avery Sinclair in Health & Wellness December 2025 • 4 min read.

"A closer look at the efficacy and safety of EUS-guided and ERCP-guided biliary drainage for treating malignant obstructions."

Biliary obstruction, a condition where the bile ducts become blocked, can lead to serious health issues if left untreated. Malignant biliary obstruction, often caused by tumors, requires effective drainage to relieve symptoms and improve patient outcomes.

Traditionally, endoscopic retrograde cholangiopancreatography (ERCP) has been the standard approach for biliary drainage. However, endoscopic ultrasound-guided biliary drainage (EUS-BD) has emerged as a promising alternative. The choice between EUS and ERCP depends on various factors, including the location and nature of the obstruction, as well as the patient's overall health.

Recent studies, including a prospective randomized trial by Park et al., have compared the efficacy and safety of EUS-BD and ERCP-BD. While the initial findings suggested similar safety profiles, ongoing discussions and further research are crucial to fully understand the advantages and limitations of each method. This article delves into the nuances of these drainage techniques, offering insights to help patients and healthcare providers make informed decisions.

EUS-BD vs. ERCP-BD: Understanding the Key Differences

Illustration of biliary drainage procedures EUS and ERCP.

ERCP involves inserting an endoscope through the mouth, esophagus, and stomach to reach the bile ducts. A catheter is then guided into the bile duct, and contrast dye is injected to visualize the obstruction. If necessary, a stent can be placed to keep the duct open.

EUS-BD, on the other hand, uses an ultrasound endoscope to visualize the bile ducts from within the stomach or duodenum. A needle is then inserted through the wall of the gastrointestinal tract to access the bile duct, and a stent is placed to create a drainage pathway.

Accessibility: EUS-BD may be preferred when ERCP is not feasible due to anatomical variations or prior surgery.
Success Rates: Both methods have high success rates, but EUS-BD may be more successful in certain situations.
Adverse Events: While both procedures carry risks, the types and frequencies of adverse events can differ.
Stent Patency: The longevity of the stent's functionality can influence the choice between EUS and ERCP.

While both methods aim to relieve biliary obstruction, their approaches differ significantly, impacting their suitability for individual cases.

Making Informed Decisions About Biliary Drainage

Choosing between EUS-BD and ERCP-BD requires careful consideration of individual patient factors, the expertise of the medical team, and the available resources. As research continues to evolve, staying informed and discussing all options with your healthcare provider is essential for achieving the best possible outcome in managing biliary obstruction.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

Everything You Need To Know

What is biliary obstruction and why is drainage necessary?

Biliary obstruction occurs when the bile ducts become blocked, preventing the normal flow of bile. This can lead to serious health problems. Drainage is essential to relieve symptoms and improve patient outcomes, especially in cases of malignant biliary obstruction, often caused by tumors. Without effective drainage, the buildup of bile can cause jaundice, infection, and liver damage.

What is the difference between ERCP and EUS-BD in treating biliary obstruction?

ERCP (Endoscopic Retrograde Cholangiopancreatography) involves inserting an endoscope through the mouth to reach the bile ducts. A catheter is guided into the bile duct, and contrast dye is injected to visualize the obstruction, potentially followed by stent placement. EUS-BD (Endoscopic Ultrasound-guided Biliary Drainage) uses an ultrasound endoscope to visualize the bile ducts from within the stomach or duodenum. A needle is then inserted through the wall of the gastrointestinal tract to access the bile duct, and a stent is placed to create a drainage pathway. The key difference lies in their approaches to access and drain the bile ducts.

When might EUS-BD be preferred over ERCP?

EUS-BD may be preferred when ERCP is not feasible. This may be due to anatomical variations or prior surgery that makes it difficult or impossible to access the bile ducts using the traditional ERCP method. While both methods aim to relieve biliary obstruction, EUS-BD offers an alternative approach, especially when ERCP presents challenges.

What factors influence the choice between EUS-BD and ERCP-BD?

The choice between EUS-BD and ERCP-BD depends on various factors, including the location and nature of the obstruction, the patient's overall health, the expertise of the medical team, and the available resources. While both methods have high success rates, the specific circumstances of each case will influence which technique is most suitable. Recent studies, like the one by Park et al., compare the efficacy and safety profiles, which also informs the decision-making process.

What are the key considerations for patients undergoing biliary drainage for malignant obstruction?

For patients, key considerations include understanding the different approaches of EUS-BD and ERCP. Patients should be aware of the potential risks and benefits associated with each procedure. Factors like accessibility due to anatomical variations, success rates, stent patency, and potential adverse events influence the choice. Discussion with the healthcare provider is essential to make informed decisions about the best treatment, considering individual circumstances and preferences to achieve the best possible outcome in managing the biliary obstruction.