EUS-guided Biliary Drainage of First Intent With the Lumen Apposing Metal Stent vs. ERCP in the Management of Malignant Distal Biliary Obstruction (AXIOS-CPRE)

Inclusion Criteria: * Radiological diagnosis (with or without pathological diagnosis) of a malignant obstruction of the borderline resectable distal bile ducts, locally advanced or unresectable distal to the hilum, at a minimum distance of 2 cm. * Resectability based on tumor staging after axial imaging and evaluation by a physician (surgeon, oncologist and / or gastroenterologist). * High results of the liver function test with a serum bilirubin level at least 3 times above the upper limit of normal (18.9 μmol / L) * Dilated extrahepatic bile duct measuring at least 1.2 cm in axial imaging, ultrasound or endoscopy. * Karnofsky index\> 30% * ASA score \<IV * Patient accepting the constraints of research * Patient affiliated or beneficiary of a social security scheme * Patient having signed an informed consent Exclusion Criteria: * \- Hilar obstruction (biliary obstruction located \<2 cm from the hilum) * Coagulopathy and / or thrombocytopenia that cannot be corrected * Age \<18 years old * Liver metastases involving\> 30% of hepatic volume * Liver cirrhosis with portal hypertension or ascites * Biliary sphincterotomy or placement of a stent performed in the past * Anatomy modified by surgery * Common bile ducts measuring less than 1.2 cm will be excluded. * Patient with clinical and radiological signs of stenosis of the gastric outlet * Patient participating in another clinical study * Protected patient: adult under guardianship, curatorship or other legal protection, deprived of liberty by judicial or administrative decision * Pregnant, breastfeeding or parturient woman * Patient hospitalized without consent