Clinical Question #13
In the setting of concomitant biliary and gastric outlet malignant obstruction, what is the best modality to achieve biliary drainage?
i-EUS suggests that, in the setting of double obstruction, ERCP may be attempted whenever the papilla is reachable (especially in type 1 or 3 stenosis) or in case of previously placed duodenal stent.
i-EUS suggests that, in naïve patients with double obstruction, EUS-guided double bypass may be considered. (Level 4 evidence; Weak recommendation)