Endoscopic ultrasound‑guided biliary drainage (EUS‑BD) is performed as a second drainage method when endoscopic retrograde cholangiopancreatography‑guided biliary drainage fails. There are several severe adverse events in EUS‑BD, and avoiding technical failure is desirable. Although EUS‑BD is a skilled endoscopic treatment, the appropriate conditions for EUS‑BD beginners are not well known. The present study aimed to clarify the appropriate cases for EUS‑BD beginners. The present retrospective cohort study included patients with malignant biliary obstruction who underwent EUS‑BD, which was performed by beginners between March 2005 and June 2024. Factors associated with successful EUS‑BD performed by beginners were evaluated by multivariate logistic regression analysis. The performance of each factor was evaluated via a receiver operating characteristic (ROC) curve. According to multivariate analysis, the diameter of the punctured bile duct was associated with successful EUS‑BD performed by beginners (odds ratio, 1.34; 95% CI, 1.03‑1.75; P=0.031). The area under the ROC curve for the diameter of the punctured bile duct was 0.79, and the cutoff value was 6.7 mm (71% sensitivity and 81.8% specificity). The diameter of the punctured bile duct might be associated with successful EUS‑BD procedures performed by beginners. When a beginner performs EUS‑BD, a diameter of the targeted bile duct >6.7 mm might be desirable for successful procedures.

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