Illustration of biliary drainage pathways comparing EUS and ERCP effectiveness

EUS vs. ERCP: Which Biliary Drainage Method Is Right for You?

Samir D’Costa 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 malignant biliary obstruction."

Biliary obstruction, especially when caused by malignancy, poses a significant challenge in gastroenterology. Effective drainage is crucial to alleviate symptoms and improve patient outcomes. Endoscopic techniques have revolutionized the management of biliary obstructions, with endoscopic ultrasound-guided biliary drainage (EUS-BD) and endoscopic retrograde cholangiopancreatography-guided biliary drainage (ERCP-BD) emerging as primary modalities.

EUS-BD and ERCP-BD each offer unique advantages and challenges. ERCP has been the traditional approach, but EUS-BD has gained traction as a viable alternative, especially when ERCP fails or is not feasible. Recent research has focused on directly comparing the efficacy and safety of these two methods to determine the optimal approach for different clinical scenarios.

This article delves into a critical analysis of a recent study comparing EUS-BD and ERCP-BD, explores the factors influencing stent patency and dysfunction, and discusses the broader implications for managing malignant biliary obstruction. We will provide a clear, accessible overview of the current landscape, helping patients and caregivers better understand the options available.

EUS-BD vs. ERCP-BD: A Closer Look at Stent Patency

Illustration of biliary drainage pathways comparing EUS and ERCP effectiveness

One of the primary considerations in biliary drainage is the long-term patency of the stents used to maintain bile flow. Stent patency refers to the duration a stent remains functional without blockage or dysfunction. Traditionally, this has been evaluated using methods like the Kaplan-Meier analysis or Cox proportional hazard models, which are statistical techniques designed to assess time-to-event data. A key study highlighted in the original article directly addresses these concerns.

In a prospective randomized trial, researchers compared EUS-BD and ERCP-BD, focusing on the duration of stent patency. The goal was to determine if one method provided a longer period of unobstructed bile flow. The trial design and sample size are critical factors in assessing the validity and applicability of the results.

Sample Size: Ensuring an adequate number of participants is essential to detect meaningful differences between the two methods.
Statistical Methods: Kaplan-Meier and Cox models are preferred for time-to-event data, providing a more accurate assessment of stent patency.
Hazard Ratio: The hazard ratio helps quantify the difference in the rate of stent dysfunction between the EUS-BD and ERCP-BD groups.

If a trial is underpowered, it may fail to detect clinically significant differences, leading to inconclusive results. Therefore, a well-designed study should include a sufficient number of patients to confidently determine whether EUS-BD offers a tangible advantage over ERCP-BD in terms of stent patency.

Navigating Biliary Drainage Options

The management of malignant biliary obstruction requires careful consideration of various factors, including the patient's overall health, the location and nature of the obstruction, and the expertise available at the treatment center. While EUS-BD holds promise as a valuable alternative to ERCP-BD, further research is needed to fully elucidate its advantages and limitations. By staying informed about the latest evidence and consulting with experienced gastroenterologists, patients and caregivers can make well-informed decisions that optimize outcomes and improve quality of life.

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 are the primary endoscopic techniques used to manage biliary obstructions caused by malignancy?

The primary endoscopic techniques used are endoscopic ultrasound-guided biliary drainage (EUS-BD) and endoscopic retrograde cholangiopancreatography-guided biliary drainage (ERCP-BD). ERCP-BD has been the traditional approach, while EUS-BD has emerged as a viable alternative, particularly when ERCP-BD fails or is not feasible. These methods aim to alleviate symptoms and improve patient outcomes by effectively draining the biliary obstruction.

What is stent patency, and why is it a critical consideration when comparing EUS-BD and ERCP-BD?

Stent patency refers to the duration a stent remains functional without blockage or dysfunction after biliary drainage. It is critical because the long-term success of biliary drainage depends on maintaining unobstructed bile flow. When comparing EUS-BD and ERCP-BD, stent patency is a primary consideration to determine which method provides a longer period of unobstructed bile flow. Statistical methods like Kaplan-Meier analysis and Cox proportional hazard models are commonly used to evaluate stent patency.

When assessing studies comparing EUS-BD and ERCP-BD, what key factors should be considered to ensure the validity and applicability of the results?

Key factors to consider include the sample size, the statistical methods used, and the hazard ratio. An adequate sample size is essential to detect meaningful differences between EUS-BD and ERCP-BD. Kaplan-Meier and Cox models are preferred for time-to-event data, providing a more accurate assessment of stent patency. The hazard ratio helps quantify the difference in the rate of stent dysfunction between the EUS-BD and ERCP-BD groups. A trial that lacks an adequate sample size may fail to detect clinically significant differences, leading to inconclusive results.

What factors influence the choice between EUS-BD and ERCP-BD for managing malignant biliary obstruction, and why is it important to stay informed about the latest evidence?

The choice between EUS-BD and ERCP-BD is influenced by factors such as the patient's overall health, the location and nature of the obstruction, and the expertise available at the treatment center. It is important to stay informed about the latest evidence because while EUS-BD holds promise as a valuable alternative to ERCP-BD, further research is needed to fully elucidate its advantages and limitations. Staying informed ensures that patients and caregivers can make well-informed decisions that optimize outcomes and improve quality of life.

How do statistical methods like Kaplan-Meier analysis and Cox proportional hazard models contribute to assessing the efficacy of biliary drainage methods such as EUS-BD and ERCP-BD?

Kaplan-Meier analysis and Cox proportional hazard models are statistical techniques used to assess time-to-event data, making them suitable for evaluating stent patency in biliary drainage. Kaplan-Meier analysis estimates the survival probability (in this case, stent patency) over time, providing a visual representation of how long stents remain functional in EUS-BD versus ERCP-BD. Cox proportional hazard models, on the other hand, allow researchers to assess the impact of various factors on stent patency while controlling for other variables, such as patient characteristics or stent type. These methods help quantify the difference in the rate of stent dysfunction, expressed as a hazard ratio, providing a more accurate and comprehensive understanding of the long-term efficacy of EUS-BD and ERCP-BD.