EUS-guided Choledochoduodenostomy vs ERCP as First Line in Malignant Distal Obstruction (CARPEDIEM Trial)

This study (called CARPEDIEM) is comparing two ways to drain a blocked bile duct in patients with cancer causing an obstruction near the bottom of the bile duct. The two approaches are: an endoscopic ultrasound-guided procedure (EUS-CD) that creates a shortcut from the bile duct directly into the small intestine, versus the traditional scope-based drainage method (ERCP). **You may be eligible if...** - You have a malignant (cancer-related) blockage of the lower bile duct - Your cancer is considered resectable or potentially resectable (surgery may still be possible) - You have signs of bile duct blockage such as elevated liver enzymes or jaundice - You need bile duct drainage before possible surgery **You may NOT be eligible if...** - Your cancer has already been deemed completely inoperable - You have had a previous bile duct drainage procedure for this condition - You have anatomy or conditions that make either procedure unsafe Talk to your doctor to see if this trial is right for you.