EGEUS ETS

Scientific Rationale

Biliary drainage represents a key therapeutic intervention in the management of benign and malignant biliary obstruction, including neoplastic strictures, complex choledocholithiasis, and post-surgical complications.

Endoscopic Retrograde Cholangiopancreatography (ERCP) remains the standard of care for biliary access and intervention. However, selective biliary cannulation may be challenging in a proportion of cases, increasing the risk of adverse events such as post-ERCP pancreatitis, bleeding, and perforation. A structured step-up approach to difficult cannulation is therefore essential to optimize technical success and patient safety.

Endoscopic Ultrasound (EUS), initially developed as a diagnostic modality, has progressively expanded into therapeutic applications. EUS-guided biliary drainage (EUS-BD) has emerged as an effective and minimally invasive alternative in cases of failed ERCP, reducing the need for percutaneous or surgical drainage and contributing to improved patient management algorithms.

The integration of ERCP and EUS within a shared decision-making pathway represents an important evolution in therapeutic endoscopy. Continuous professional education is required to ensure appropriate indication, technical proficiency, and evidence-based application of these complementary techniques.

This webinar aims to:

• Provide an evidence-based update on step-up strategies for difficult biliary cannulation during ERCP;
• Discuss indications and clinical outcomes of EUS-guided biliary drainage following failed ERCP in both benign and malignant diseases;
• Promote a structured and patient-centered algorithm for biliary drainage;
• Enhance procedural safety and quality of care through expert international discussion.

The educational content is exclusively scientific in nature and is intended to support the appropriate and rational use of endoscopic techniques in accordance with current international guidelines.

Educational Rationale

Rapid technological advancements and the expansion of therapeutic EUS demand structured educational programs aimed at:

• Updating endoscopists on step-up strategies for difficult biliary cannulation
• Defining evidence-based indications for EUS-guided biliary drainage
• Optimizing procedural sequencing between ERCP and EUS
• Reducing complication rates through tailored technical approaches
• Promoting multidisciplinary and algorithm-driven clinical decision-making

This international webinar is designed to provide an in-depth scientific update on:

1. ERCP and biliary cannulation as a structured step-up process, with emphasis on advanced techniques in difficult cases.
2. The role of EUS after failed ERCP in both benign and malignant biliary diseases.
3. Integration of conventional and EUS-guided approaches within modern biliary drainage algorithms.
4. Expert discussion and interactive exchange among European specialists to align best practices

Learning Objectives

At the end of the webinar, participants will be able to:

• Apply evidence-based algorithms in the management of biliary obstruction.
• Recognize predictors of difficult ERCP and implement appropriate escalation strategies.
• Understand indications, technical aspects, and outcomes of EUS-guided biliary drainage.
• Optimize patient safety by minimizing procedure-related complications.
• Integrate EUS and ERCP within a comprehensive therapeutic strategy tailored to individual patient scenarios.