[Therapeutic Endoscopic Ultrasound (EUS) - From Diagnostic Tool to Central Pillar in the Malignant (Palliative) Setting].

Authors

Armin Kuellmer

Published in

Deutsche medizinische Wochenschrift (1946). Volume 151. Issue 22. Pages 1213-1218. Epub Nov 02, 2026.

Abstract

Endoscopic biliary drainage remains the standard treatment for malignant biliary obstruction, with metal stent placement used for distal strictures. Percutaneous transhepatic cholangiodrainage (PTCD) has traditionally served as the rescue procedure following failed ERCP, though it typically requires multiple interventions to establish adequate drainage and often results in a permanent external catheter. EUS-guided biliary drainage (EUS-BD) has emerged as an alternative to PTCD in this setting. Comparative studies demonstrate that EUS-BD achieves comparable technical and clinical success to PTCD while showing lower rates of adverse events and reinterventions, supporting its consideration as a standard rescue option after unsuccessful ERCP. A parallel paradigm shift is occurring in the management of malignant gastric outlet obstruction. Surgical gastroenterostomy has long been considered the gold standard, with duodenal stenting serving as an endoscopic alternative for patients unfit for surgery, albeit with frequently limited durability of symptom control. EUS-guided gastroenterostomy (EUS-GE) has shown lower reintervention rates than duodenal stenting in randomized controlled trials. More recently, RCTs have demonstrated that EUS-GE offers efficacy comparable to, and in some outcomes superior to, surgical gastroenterostomy, with at least non-inferior results on longer-term follow-up. Together, these findings position EUS-guided techniques as increasingly favorable options over conventional percutaneous and surgical approaches for malignant biliary and gastric outlet obstruction, warranting broader incorporation into standard treatment algorithms.

PMID:
42971239
Bibliographic data and abstract were imported from PubMed on 03 Nov 2026.

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