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Updated: Aug 12, 2025
Endoscopic Ultrasound-Guided Biliary Drainage: Endoscopic Ultrasound-Guided Hepaticogastrostomy in Malignant Biliary Obstruction
Published on: March 25, 2022
EUS-Guided Biliary Drainage Versus ERCP in Malignant Biliary Obstruction Before Hepatobiliary Surgery: An
Amy Tyberg1, Avik Sarkar1, Haroon M Shahid1
1Gastroenterology, Robert Wood Johnson Medical School, New Brunswick, NJ.
Insights
Endoscopic ultrasound-guided biliary drainage (EUS-BD) before surgery leads to better outcomes than endoscopic retrograde cholangiopancreatography (ERCP). Patients undergoing EUS-BD experienced higher surgical success and shorter hospital stays, making it a preferred option.
Area of Science:
- Gastroenterology
- Surgical Oncology
- Interventional Endoscopy
Background:
- Endoscopic ultrasound-guided biliary drainage (EUS-BD) is preferred for patients unsuitable for endoscopic retrograde cholangiopancreatography (ERCP).
- Outcomes for patients undergoing hepatobiliary surgery after EUS-BD for malignancy are not well-established.
Purpose of the Study:
- To compare the outcomes of hepatobiliary surgery following EUS-BD versus ERCP in patients with malignancy.
Main Methods:
- An international, multicenter retrospective study compared 145 patients (58 EUS-BD, 87 ERCP) who underwent hepatobiliary surgery.
- Data collected included demographics, procedural details, and follow-up care.
Main Results:
- Surgical technical and clinical success rates were significantly higher after EUS-BD (97%) compared to ERCP (83% and 75%, respectively).
- The EUS-BD group had a significantly shorter hospital stay (10 days vs. 19 days).
- Endoscopic success and adverse event rates were comparable between EUS-BD and ERCP.
Conclusions:
- EUS-BD prior to hepatobiliary surgery is associated with improved surgical outcomes and reduced hospital stay compared to ERCP.
- EUS-BD may be a superior approach for patients requiring biliary drainage before major surgery for malignancy.
Introduction:
Endoscopic ultrasound-guided biliary drainage (EUS-BD) is the procedure of choice for patients who cannot undergo endoscopic retrograde cholangiopancreatography (ERCP). The outcomes of patients undergoing surgery after EUS-BD for malignancy are unknown.
Methods:
We conducted an international, multicenter retrospective comparative study of patients who underwent hepatobiliary surgery after having undergone EUS-BD or ERCP from 6 tertiary care centers. Patient demographics, procedural data, and follow-up care were collected in a registry.
Results:
One hundred forty-five patients were included: EUS-BD n=58 (mean age 66, 45% male), ERCP n=87 (mean age 68, 53% male). The majority of patients had pancreatic cancer, cholangiocarcinoma, or gallbladder malignancy. In the EUS-BD group, 29 patients had hepaticogastrostomy, 24 had choledochoduodenostomy, and 5 had rendezvous technique done. The most common surgery was Whipple in both groups (n=41 EUS-BD, n=56 ERCP) followed by partial hepatectomy (n=7 EUS-BD, n=14 ERCP) and cholecystectomy (n=2 EUS-BD, n=2 ERCP). Endoscopy clinical success was comparable in both groups (98% EUS-BD, 94% ERCP). Adverse event rates were similar in both groups: EUS-BD (n=10, 17%) and ERCP (n=23, 26%). Surgery technical success and clinical success were significantly higher in the EUS-BD group compared with the ERCP group (97% vs. 83%, 97% vs. 75%). Total Hospital stay from surgery to discharge was significantly higher in the ERCP group (19 d vs. 10 d, P =0.0082).
Discussion:
Undergoing EUS-BD versus ERCP before hepatobiliary surgery is associated with fewer repeat endoscopic interventions, shorter duration between endoscopy and surgical intervention, higher rates of surgical clinical success, and shorter length of hospital stay after surgery.
