Tanyaporn ChantarojanasiriThawee Ratanachu-EkNonthalee PausawasdiSiriraj HospitalRajavithi Hospital2022-08-042022-08-042021-05-01Clinical Endoscopy. Vol.54, No.3 (2021), 301-30822342443223424002-s2.0-85107374085https://repository.li.mahidol.ac.th/handle/20.500.14594/78212Endoscopic retrograde cholangiopancreatography (ERCP) is the primary treatment modality for bile duct obstruction. When ERCP is unsuccessful, percutaneous transhepatic biliary drainage can be an alternative method. Endoscopic ultrasound-guided biliary drainage (EUS-BD) has emerged as a treatment option for biliary obstruction, especially after ERCP failure. EUS-BD offers transluminal intrahepatic and extrahepatic drainage through a transgastric and transduodenal approach. EUS-guided hepaticogastrostomy (EUS-HGS) is an excellent choice for patients with hilar strictures or those with a surgically altered anatomy. The optimal steps in EUS-HGS are case selection, bile duct visualization, puncture-site selection, wire insertion and manipulation, tract dilation, and stent placement. Caution should be taken at each step to prevent complications. Dedicated devices for EUS-HGS have been developed to improve the technical success rate and reduce complications. This technical review focuses on the essential practical points at each step of EUS-HGS.Mahidol UniversityMedicineArticleSCOPUS10.5946/ce.2021.103