World J Gastroenterol. 2025 Dec 7;31(45):112436. doi: 10.3748/wjg.v31.i45.112436.
ABSTRACT
The management of biliary strictures is challenging both diagnostically and therapeutically, requiring a combination of advanced endoscopic techniques. Endoscopic retrograde cholangiopancreatography (ERCP) remains the gold standard for therapeutic interventions, including biliary drainage, stent placement, and tissue sampling via brush cytology or forceps biopsy. However, ERCP may not be suitable for obtaining deep tissue samples and can lead to complications such as post-ERCP pancreatitis. Endoscopic ultrasound (EUS) has emerged as a complementary modality, offering high-resolution imaging of the biliary tree and adjacent structures. EUS-guided fine-needle aspiration (EUS-FNA) and EUS-guided fine-needle biopsy (EUS-FNB) improve diagnostic accuracy, especially where ERCP-based sampling is inconclusive. Additionally, EUS plays an increasingly therapeutic role in the management of biliary strictures, particularly through EUS-guided biliary drainage, which is an effective alternative when ERCP fails due to surgically altered anatomy or inaccessible strictures. This review discusses the use of EUS and ERCP in the management of biliary strictures, highlighting their strengths and limitations, and proposes a stepwise and integrated approach. This strategy may enhance diagnostic precision and expand therapeutic options, particularly in indeterminate or complex clinical scenarios.
PMID:41378323 | PMC:PMC12687019 | DOI:10.3748/wjg.v31.i45.112436