Update on biliary endoscopy: a comprehensive review.

Introduction: Endoscopic retrograde cholangiopancreatography (ERCP) has shifted from diagnostic to therapeutic procedures such as stone extraction and biliary drainage. In addition, endoscopic ultrasonography (EUS) has an important role in biliary endoscopy, too. While the role of endoscopy for biliary tract diseases has expanded to various indications, endoscopists need to select appropriate procedures or devices from various options.

Area covered: Our review covers various aspects of endoscopic procedures for biliary tract diseases. To support this review, a PubMed search was conducted on biliary endoscopy, focusing on the most relevant papers with no time restrictions. Treatment selection for bile duct stones includes ampullary interventions and peroral cholangioscopy-guided lithotripsy. Biliary drainage using fully covered metal stents are widely selected both for distal malignant and benign biliary strictures but plastic stents are recently preferred for unresectable hilar malignant biliary obstruction. EUS-guided biliary drainage (EUS-BD) is now established as an option in difficult ERCP but can be a first-line treatment if expertise is available.

Expert opinion: Modified biliary stents are developed, such as inside stents, stents with antimigration or antireflux features and an individualized approach needs to be investigated. EUS-BD can be applied to various procedures, but its training is to be established for safe performance.