ELEMENT trial - EUS-CDS and ERCP RCT in stage-3/4 extrahepatic BD obstruction
70 patients randomized to each EUS-CDS (6x8 mm axios) and ERCP arm EUS-CDS was quicker (14 mins vs 24 mins), had similar technical and clinical success Same rate of early adverse events, and delayed stent obstruction 5-8% underwent Whipples - no increased difficulty with whipple in EUS-CDS arm (similar surgical duration, similar adverse event, similar post-op hospitalization duration) when compared to ERCP Zero risk of pancreatitis - as expected.