EUS-guided transhepatic biliary drainage: a large single-center U.S. experience

Area of Science:

• Gastroenterology
• Interventional Endoscopy
• Biliary Interventions

Background:

• EUS-guided hepaticogastrostomy, now termed EUS-guided transhepatic biliary drainage (ETBD), has international experience.
• ETBD offers access to intrahepatic bile ducts via various luminal and biliary approaches.
• This study presents the largest U.S. single-center experience with ETBD.

Purpose of the Study:

• To evaluate the efficacy and safety of ETBD in managing benign and malignant biliary diseases.
• To assess ETBD outcomes in patients with native and surgically altered anatomy.
• To report the largest U.S. single-center experience with ETBD.

Main Methods:

• Retrospective analysis of ETBD procedures performed by a single endoscopist from September 2014 to May 2021.
• Inclusion of 215 patients with benign (n=85) and malignant (n=130) biliary obstruction.
• Data collection on patient demographics, anatomy, procedural details, success rates, adverse events, and follow-up.

Main Results:

• Technical success rate of 95.3% and clinical success rate of 87.25% in 215 attempted ETBD procedures.
• High prevalence of surgically altered anatomy (43%) and prior failed endoscopic attempts (43%).
• Modest adverse event rate (18.6%), with 34.4% mortality in the malignant cohort during follow-up.

Conclusions:

• ETBD is a viable and effective treatment for biliary obstruction in patients with both native and surgically altered anatomy.
• The procedure demonstrates a favorable balance of efficacy and safety.
• ETBD offers a valuable therapeutic option for complex biliary interventions.