Postprocedural pancreatitis remains the most frequent adverse event following Endoscopic Retrograde Cholangiopancreatography (ERCP), particularly when performed for malignant distal biliary obstruction. A randomized trial evaluated whether Endoscopic Ultrasound‑Guided Choledochoduodenostomy (EUS-CDS) using a lumen-apposing metal stent could offer a safer primary drainage strategy. The study compared the two procedures in 220 patients with obstructive jaundice due to malignant distal biliary obstruction and a dilated common bile duct (≥15 mm).
EUS-CDS significantly reduced the risk of postprocedural acute pancreatitis compared with ERCP (1.8% vs 7.3%; relative risk 0.25). Technical success was also higher with EUS-CDS (94.6% vs 78.9%), and procedures were shorter on average (13.5 vs 24.7 minutes). Rates of overall adverse events were similar between the groups (19.8% vs 21.1%), with no…
