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Updated: Jun 9, 2025
Endoscopic Ultrasound-Guided Biliary Drainage: Endoscopic Ultrasound-Guided Hepaticogastrostomy in Malignant Biliary Obstruction
Published on: March 25, 2022
Hepaticogastrostomy versus hepaticogastrostomy with antegrade stenting for malignant biliary obstruction: a
Panagiotis Paraskevopoulos1, Mahmoud Obeidat1, Dániel Bednárik1,2
1Centre for Translational Medicine, Semmelweis University, Budapest, Hungary.
Insights
Combining antegrade stenting (AGS) and hepaticogastrostomy (HGS) for difficult biliary access, known as HGAS, shows improved clinical success and fewer re-interventions. This endoscopic ultrasound-guided approach offers a promising alternative for complex cases.
Area of Science:
- Gastroenterology and Hepatology
- Interventional Endoscopy
- Biliary Interventions
Background:
- Endoscopic ultrasound-guided antegrade stenting (AGS) and hepaticogastrostomy (HGS) are crucial when standard ERCP fails.
- The combined HGS with AGS (HGAS) technique is gaining traction for complex biliary drainage.
- Assessing HGAS efficacy against HGS alone is vital for clinical decision-making.
Purpose of the Study:
- To comprehensively evaluate the benefits and drawbacks of combined HGAS versus HGS alone.
- To compare technical success, clinical success, adverse events, and re-intervention rates.
- To analyze stent patency and overall survival outcomes between the two procedures.
Main Methods:
- A random-effects meta-analysis was conducted following PRISMA guidelines.
- Data were extracted from 26 eligible studies encompassing 788 HGS and 295 HGAS cases.
- Pooled rates and odds ratios (OR) with 95% confidence intervals (CI) were calculated for comparative analysis.
Main Results:
- Pooled technical success was 94% for HGS and 89% for HGAS; clinical success was 88% for HGS and 94% for HGAS.
- Adverse event rates were 20% for HGS and 14% for HGAS, with significantly lower re-intervention rates for HGAS (OR=0.37).
- Time to stent dysfunction was longer for HGAS (333 days) compared to HGS (209 days), with no significant difference in overall survival.
Conclusions:
- HGAS demonstrates potential for increased clinical success and reduced re-intervention needs.
- While overall adverse events were similar, HGAS showed a decrease in bile leakage.
- The HGAS technique appears to prolong stent patency without impacting overall survival, offering a valuable alternative for challenging biliary interventions.
Background:
Combining antegrade stenting (AGS) and hepaticogastrostomy (HGS) is an increasingly used endoscopic ultrasound-guided intervention when stenting by endoscopic retrograde cholangiopancreatography is impossible.
Objectives:
We comprehensively assessed the benefits and downsides of combined AGS and HGS (HGS procedure with AGS, HGAS).
Data Sources And Methods:
From 788 HGS and 295 HGAS cases, a random-effects meta-analysis was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol. Five electronic databases were searched for studies on HGS with or without AGS from inception until May 2024. The odds ratio (OR) and pooled rates were used for single and two-arm comparisons with 95% confidence intervals (CI).
Results:
From 26 eligible studies. The pooled technical and clinical success was 94% (CI: 92%-96%) and 88% (CI: 84%-91%) for HGS and 89% (CI: 83%-93%) and 94% (CI: 89%-97%) for HGAS, respectively. Pooled OR of HGAS and HGS showed an OR = 0.38 (CI: 0.07-2.00) for technical success and an OR = 1.02 (CI: 0.50-2.06) for clinical success. The pooled adverse event rates were 20% (CI: 16%-25%) for HGS and 14% (CI: 9%-20%) for HGAS, whereas pooled OR showed an OR = 1.09 (CI: 0.30-3.94). For re-intervention, an OR = 0.37 (CI: 0.27-0.52) was found. Time to stent dysfunction increased, HGAS 333 (CI: 280-Not reached) and HGS 209 (CI: 120-325) with no change in overall survival HGS 117 (CI: 94-147) and 140 (CI: 105-170).
Conclusion:
The use of HGAS appears to increase clinical success and reduce the need for re-intervention. Overall adverse event rates were similar but bile leakage prevalence was decreased. Time to stent dysfunction seems to increase with no change in overall survival.
Trial Registration:
Our protocol was prospectively registered with PROSPERO (CRD42024509412).
