International Consensus Statements on Endoscopic Ultrasound-Guided Biliary Drainage: Results From the 1st JGES International in 2025

Abstract

EUS-guided biliary drainage (EUS-BD) has evolved as an alternative to ERCP-BD for biliary obstruction, but its role as a primary drainage and its terminology have not been standardized.

Aims

To establish an international consensus on the indications, techniques, and standardized terminology of EUS-BD.

Methods

To address these, an international consensus meeting was held during the 1st JGES International. Fourteen expert endoscopists from six countries participated in a structured Delphi process, reviewing evidence and voting on clinical questions related to EUS-BD indications, techniques, and terminology, particularly for unresectable malignant distal biliary obstruction (MDBO) and for biliary diseases in patients with surgically altered anatomy (SAA).

Results

For unresectable MDBO, EUS-BD was recognized as a safe and effective alternative to ERCP-BD, although it is not yet established as a standard first-line approach. It is an established salvage option after failed ERCP and may be considered as an upfront option in selected patients such as those with duodenal obstruction preventing access to the papilla. The choice between choledochoduodenostomy and hepaticogastrostomy varies among countries depending on device availability and expertise. In patients with SAA, EUS-BD showed higher technical success and shorter procedure time than balloon endoscopy–assisted ERCP, though either approach may be selected based on institutional and endoscopist experience. A unified terminology for interventional EUS is also proposed, including the concepts of anastomosis versus drainage and trans-ESCR (endosonographically created route) procedures.

Conclusions

This consensus highlights the need for standardized global terminology and further trials to define the optimal role of EUS-BD for biliary diseases.