Endoscopic ultrasound (EUS) is one of the major innovations that has played a transformative role in gastroenterologyand related disciplines. With its evolution, its use has expanded from simple diagnosis to management of various gastroenterologicalconditions, such as biliary strictures.

In light of these advancements, in the present review, we summarize the current evidence on the transformativerole of EUS in the diagnosis and management of biliary strictures. Two independent reviewers conducted a literature search using fiveelectronic databases, PubMed, CENTRAL, Science Direct, Google Scholar, and EMBASE for all available literature published up toJanuary 2025. Articles that met our inclusion criteria were included in the review, and statistical software was used to analyze thereported outcomes.

Our literature search yielded 935 articles, of which 19 met our inclusion criteria and were included in the review. Ten articlesfocused on EUS as a diagnostic method, and nine focused on EUS-guided therapeutic interventions. Our meta-analysis results showedthat EUS fine-needle aspiration (EUS-FNA) is superior to conventional techniques for diagnosing malignant biliary strictures. Thesensitivity of EUS-FNA ranged from (0.43; 95% CI [0.24, 0.63]) to (1.00; 95% CI [0.79, 1.00]) compared to that of conventionaldiagnostic methods, which ranged from (0.36; 95% CI [0.19, 0.56]) to (0.96; 95% CI [0.90, 0.99). Both EUS-FNA and conventionaldiagnostic methods exhibit a high specificity for diagnosing biliary strictures, with most having a specificity of 100%. In managingbiliary strictures, we found that EUS-guided intervention exhibited a significantly higher clinical success rate than controlinterventions (OR: 2.89; 95% CI [1.22, 6.84] p = 0.02). However, no significant difference was observed when the technical successrates were pooled (odds ratio [OR], 0.97; 95% CI [0.30, 3.16] p = 0.96).

EUS has been shown to be a promising tool for the diagnosis and management of biliary strictures. Furthermore, asempirical evidence indicates, through a combination of EUS-guided and conventional interventions, diagnostic performance improvessignificantly. Therefore, we recommend that the feasibility and use of EUS-guided interventions in the diagnosis and management ofbiliary strictures should be investigated in greater depth.