Endoscopic Ultrasound‐Guided Bile Duct Drainage Enhances Oncological Systemic Therapy Initiation and Capability in Patients With Non‐Resectable Malignant Distal Bile Duct Obstructions Compared to Percutaneous Transhepatic Biliary Drainage

Introduction Endoscopic retrograde cholangiopancreaticography (ERCP) is the gold standard for bile duct drainage in non‐resectable malignant distal bile duct obstruction with jaundice in pancreaticobiliary and duodenal neoplasia. Failed ERCP is either followed by endoscopic ultrasound‐guided biliary drainage (EUS‐BD) or percutaneous transhepatic biliary drainage (PTBD) as an alternative procedure. This study compares the ability to initiate and continue oncological systemic therapy in patients treated with EUS‐BD versus PTBD. Methods In this retrospective, comparative cohort study, 96 consecutive patients were analyzed. Oncological, demographic, and laboratory parameters were examined, focusing on the capability to initiate chemotherapy and the time interval from intervention to chemotherapy initiation. Results The EUS‐BD group showed a greater reduction in serum bilirubin levels before chemotherapy (2.2 mg/dL vs. 3.9 mg/dL, p = 0.04) and had a significantly greater degree of change in bilirubin levels after 10 days (70% vs. 30%, p = 0.01). More patients in the EUS‐BD cohort received chemotherapy (69% vs. 48%, p = 0.04), and the interval between intervention and chemotherapy initiation was shorter (10 vs. 17 days, p = 0.02). The type and number of chemotherapies administered did not differ significantly between the groups ( p = 0.43; p = 0.50; p = 0.12). Reinterventions and complication rates were significantly lower in the EUS‐BD cohort (6% vs. 60%, p = 0.004 and 56% vs. 92%, p = 0.004). Conclusion EUS‐BD appears superior to PTBD in facilitating the initiation of oncological systemic therapy, with fewer complications and a shorter time to treatment initiation. Further multicenter studies are needed to confirm these findings.