A novel endoscopic approach improves biliary drainage outcomes for patients with altered anatomy.

• Technical success rate: 87.3%, clinical success: 93.8%.
• Adverse event rate: 20%, with 30.6% persistent fistula rate within 3 months.

Consider this technique for patients with complex anatomy, especially when multiple biliary interventions are needed.

• Most common indication: benign strictures (58.2%).