To evaluate the effectiveness and safety of extra-anatomical endoscopic access to the bile ducts in the treatment of patients with benign and malignant biliary strictures.

A prospective analysis of treatment outcomes of all patients with obstructive jaundice due to biliary strictures who underwent endoscopic treatment between 2016 and 2023 at the Department of General, Gastroenterological and Oncological Surgery, Collegium Medicum, Nicolaus Copernicus University in Toruń. The study group consisted of patients in whom transpapillary access to the bile ducts could not be obtained during ERCP, and in whom EUS-guided transmural access was therefore used during endotherapy.

In 343 patients in whom transpapillary access during ERCP was unsuccessful, transmural EUS-guided techniques were employed. Endoscopic transpapillary biliary stenting using EUS-guided transmural access was performed in 56/343 (16.32%) patients. In the remaining 287/343 (83.67%) patients, extra-anatomical EUS-guided transmural biliary–enteric anastomosis was created. Technical success was achieved in 330/343 (96.21%) patients, and clinical success in 302/343 (88.05%) patients. Complications occurred in 46/343 (13.41%) patients, including fatal complications in 9/343 (2.62%).

Endoscopic techniques utilizing EUS-guided transmural access are effective and safe in the endotherapy of patients with biliary strictures and constitute an alternative to surgical techniques in cases where transpapillary drainage during ERCP is unsuccessful.