EUS‐guided biliary and pancreatic duct interventions

Endoscopic retrograde cholangio-pancreatography (ERCP) is the standard treatment modality for decompression of the obstructed biliary tree [1]. ERCP may fail to achieve deep biliary cannulation in about 5–10% patients due to anatomical or technical causes. Traditionally, percutaneous biliary drainage (PTBD) has been employed to achieve biliary decompression in such situations. PTBD has been reported to have complication rates up to 15% [2–6]. EUS guided intervention is an attractive alternative in these patients. Under EUS guidance, one can puncture the biliary tract, obtain a cholangiogram and achieve biliary drainage.