Efficacy and safety of EUS-guided hepatogastrostomy: A systematic review and meta-analysis

EUS-guided hepaticogastrostomy (EUS-HGS) is one of the preferred methods in biliary drainage where ERCP fails or is contraindicated. The clinical outcomes of EUS-HGS are not well studied because of variability in procedure technique. We conducted a search of multiple electronic databases and conference proceedings from inception through January 2023. The clinical outcomes studied were pooled technical success, clinical success, and adverse events. Standard meta-analysis methods were used using the random-effects model, and heterogeneity was studied by I ² statistics. We analyzed 44 studies, which included 19 prospective and 25 retrospective studies. The pooled technical success rate of EUS-HGS was 94.4% (confidence interval [CI], 92.4%-95.9%; I ² = 0%), and the pooled clinical success rate was 88.6% (CI, 83.7%-92.2%; I ² = 0%). The pooled adverse outcomes with EUS-HGS were 23.8% (CI, 19.6%-28.5%; I ² = 0%). The mild adverse event rate associated with HGS was 5.8% (4.2%-8.1%; I ² = 0%), moderate adverse event rate was 12.1% (9.1%-15.8%; I ² = 16%), and severe adverse event rate was 4.2% (3.0%-5.7%; I ² = 61%), whereas fatal adverse event rate was 3.2% (1.9%-5.4%; I ² = 62%). On subgroup analysis, the pooled rate of adverse events of EUS-guided hepaticogastrostomy with antegrade stenting was 13.3% (95% CI, 8.2%-21.0%). The pooled technical success with EUS-guided hepaticogastrostomy with antegrade stenting was 89.7% (95% CI, 82.6%-94.2%), and clinical success was 92.5% (95% CI, 77.9%-97.7%). On the basis of our analysis of EUS-HGS, the overall technical success was 94.4%, and the clinical success rate was 88.6%, and the overall adverse events were reported to be 23.8%. These data can also help improve the clinical benefits of EUS-HGS in the selected patients in whom it is performed.