STUDY PROTOCOL Open Access ELEMENT TRIAL: study protocol for a randomized controlled trial on endoscopic ultrasound-guided biliary drainage of first intent with a lumen-apposing metal stent vs. endoscopic retrograde cholangio- pancreatography in the management of malignant distal biliary obstruction Yen-I Chen 1* , Kashi Callichurn 2 , Avijit Chatterjee 3 , Etienne Desilets 4 , Donnellan Fergal 5 , Nauzer Forbes 6 , Ian Gan 5 , Sana Kenshil 3 , Mouen A. Khashab 7 , Rastislav Kunda 8 , Eric Lam 9 , Gary May 10 , Rachid Mohamed 6 , Jeff Mosko 10 , Sarto C. Paquin 2 , Anand Sahai 2 , Gurpal Sandha 11 , Christopher Teshima 10 , Alan Barkun 1 , Jeffrey Barkun 12 , Ali Bessissow 13 , Kristina Candido 1 , Myriam Martel 1 , Corey Miller 1 , Kevin Waschke 1 , George Zogopoulos 12 , Clarence Wong 14

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