Evidence on the safety and efficacy of endoscopic ultrasound-guided biliary drainage (EUS‑BD) for biliary obstruction caused by distal malignant disease is adequate to support using this procedure. This is provided that standard arrangements are in place for clinical governance, consent and audit. Find out what standard arrangements mean on the NICE guidance page.
Evidence on the safety and efficacy of EUS‑BD for biliary obstruction caused by malignant hilar or benign disease is inadequate in quality and quantity. So, this procedure should be used only in research. Find out what only in research means on the NICE guidance page.
Further research should report details of patient selection, where the obstruction is, and whether this procedure has been done after failed endoscopic retrograde cholangiopancreatography.
Patient selection should be done by a multidisciplinary team or, in an emergency, only after agreement with an experienced hepatobiliary team.
This procedure should only be done in specialised centres by a clinician with specific training and experience in the procedure.