Background and Objectives: EUS-guided biliary drainage (EUS-BD) was shown to be useful for malignant biliary obstruction (MBO). However, there is lack of consensus on how EUS-BD should be performed. Methods: This was a worldwide multi-institutional survey among members of the International Society of EUS conducted in February 2018. The survey consisted of 10 questions related to the practice of EUS-BD. Results: Forty-six endoscopists of them completed the survey. The majority of endoscopists felt that EUS-BD could replace percutaneous transhepatic biliary drainage after failure of ERCP. Among all EUS-BD methods, the rendezvous stenting technique should be the first choice. Self-expandable metal stents (SEMSs) were recommended by most endoscopists. For EUS-guided hepaticogastrostomy (HGS), superiority of partially-covered SEMS over fully-covered SEMS was not in agreement. 6-Fr cystotomes were recommended for fistula creation. During the HGS approach, longer SEMS (8 or 10 cm) was recommended. During the choledochoduodenostomy approach, 6-cm SEMS was recommended. During the intrahepatic (IH) approach, the IH segment 3 was recommended. Conclusion: This is the first worldwide survey on the practice of EUS-BD for MBO. There were wide variations in practice, and randomized studies are urgently needed to establish the best approach for the management of this condition.

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Keywords Consensus, EUS-guided biliary drainage, Questionnaire survey
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Journal Endoscopic Ultrasound
Guo, J. (Jintao), Giovannini, M. (Marc), Sahai, A.V. (Anand V.), Saftoiu, A, Dietrich, C.F, Santo, E. (Erwin), … Sun, S. (Siyu). (2018). A multi-institution consensus on how to perform EUS-guided biliary drainage for malignant biliary obstruction. Endoscopic Ultrasound, 7(6), 356–365. doi:10.4103/eus.eus_53_18