EUS-Guided Antegrade Stenting

EUS-guided biliary drainage (EUS-BD) covers multiple techniques, all of which have been studied and applied in clinical practice for the last two decades [1-4]. EUS-BD can be performed by one of the three approaches [1]. First, a rendezvous technique may be performed whereby a wire is placed into an intrahepatic or extrahepatic bile duct, advanced through the papilla and is retrieved by a duodenoscope for biliary interventions. Second, direct transluminal stenting using a transgastric or transduodenal approach may be achieved without accessing the papilla. A third approach that has not been expansively reported is EUS-guided antegrade transpapillary (or trans-anastomotic) biliary stent (AGS) placement [5].