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Updated: Nov 27, 2025
Endoscopic Ultrasound-Guided Biliary Drainage: Endoscopic Ultrasound-Guided Hepaticogastrostomy in Malignant Biliary Obstruction
Published on: March 25, 2022
EUS-guided intrahepatic biliary drainage: a large retrospective series and subgroup comparison between percutaneous
Giuseppe Vanella1,2, Michiel Bronswijk1, Geert Maleux3
1Department of Gastroenterology and Hepatology, University Hospital Gasthuisberg, University of Leuven, Leuven, Belgium.
Insights
Endoscopic ultrasound-guided intrahepatic biliary drainage (EUS-IBD) demonstrates high success and safety, particularly for complex cases. EUS-IBD shows superiority over percutaneous drainage (PTBD) in treating proximal strictures and altered anatomy.
Area of Science:
- Gastroenterology
- Interventional Endoscopy
- Biliary Interventions
Background:
- Endoscopic ultrasound-guided intrahepatic biliary drainage (EUS-IBD) is underutilized compared to percutaneous drainage (PTBD).
- Limited data exists for EUS-IBD in hilar stenoses or postsurgical anatomy.
- This study evaluates EUS-IBD techniques and compares them to PTBD in challenging cases.
Purpose of the Study:
- To assess the efficacy and safety of different EUS-IBD techniques (Rendez-vous, antegrade stenting, hepatico-gastrostomy).
- To compare EUS-IBD with PTBD in patients with proximal biliary stenosis or surgically altered anatomy.
- To evaluate outcomes including technical/clinical success, adverse events, and reinterventions.
Main Methods:
- Retrospective analysis of 104 EUS-IBD procedures (2012-2019).
- Comparison of Rendez-vous, antegrade stenting, and hepatico-gastrostomy.
- 1:1 matched comparison of EUS-IBD versus PTBD for proximal stenosis/altered anatomy.
Main Results:
- High technical (89.4%) and clinical success (96.2%) for EUS-IBD.
- Hepatico-gastrostomies with dedicated stents were shorter and showed a trend towards less dysfunction.
- In complex cases, EUS-IBD achieved higher clinical success (97.4% vs. 79.5%), less pain, shorter hospital stays, and fewer reinterventions compared to PTBD.
Conclusions:
- EUS-IBD is a safe and effective procedure with high success rates.
- Hepatico-gastrostomy outcomes are comparable and may improve with specialized tools.
- EUS-IBD is superior to PTBD for managing proximal biliary strictures and surgically altered anatomy.
Abstract:
Background and study aims Endoscopic ultrasound-guided intrahepatic biliary drainage (EUS-IBD) struggles to find a place in management algorithms, especially compared to percutaneous drainage (PTBD). In the setting of hilar stenoses or postsurgical anatomy data are even more limited. Patients and methods All consecutive EUS-IBDs performed in our tertiary referral center between 2012 - 2019 were retrospectively evaluated. Rendez-vous (RVs), antegrade stenting (AS) and hepatico-gastrostomies (HGs) were compared. The predefined subgroup of EUS-IBD patients with proximal stenosis/surgically-altered anatomy was matched 1:1 with PTBD performed for the same indications. Efficacy, safety and events during follow-up were compared. Results One hundred four EUS-IBDs were included (malignancies = 87.7 %). These consisted of 16 RVs, 43 ASs and 45 HGs. Technical and clinical success rates were 89.4 % and 96.2 %, respectively. Any-degree, severe and fatal adverse events (AEs) occurred in 23.3 %, 2.9 %, and 0.9 % respectively. Benign indications were more common among RVs while proximal stenoses, surgically-altered anatomy, and disconnected left ductal system among HGs. Procedures were shorter with HGs performed with specifically designed stents (25 vs . 48 minutes, P = 0.004) and there was also a trend toward less dysfunction with those stents (6.7 % vs . 30 %, P = 0.09) compared with previous approaches. Among patients with proximal stenosis/surgically-altered anatomy, EUS-IBD vs. PTBD showed higher rates of clinical success (97.4 % vs. 79.5 %, P = 0.01), reduced post-procedural pain (17.8 % vs. 44.4 %, p = 0.004), shorter median hospital stay (7.5 vs 11.5 days, P = 0.01), lower rates of stent dysfunction (15.8 % vs. 42.9 %, P = 0.01), and the mean number of reinterventions was lower (0.4 vs. 2.8, P < 0.0001). Conclusions EUS-IBD has high technical and clinical success with an acceptable safety profile. HGs show comparable outcomes, which are likely to further improve with dedicated tools. For proximal strictures and surgically-altered anatomy, EUS-IBD seems superior to PTBD.
