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Endoscopic ultrasound–guided choledochoduodenostomy (EUS-CD) remains the most common approach for performing EUS-guided biliary drainage. Traditional approaches use a multistep approach involving transduodenal needle access, injection of contrast into the duct, tract dilation, and ultimately, stent deployment. This paper evaluates an alternate single-step approach to EUS-CD.
The authors retrospectively evaluated 46 patients with malignant biliary obstruction who previously experienced a failed endoscopic retrograde cholangiopancreatography (ERCP)–based attempt to drain the obstructed biliary tree. These patients underwent direct EUS-guided access and drainage of the bile ducts using an electrocautery-enhanced lumen-apposing metal stent (LAMS…