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Updated: Jan 14, 2026
Endoscopic Ultrasound-Guided Biliary Drainage: Endoscopic Ultrasound-Guided Hepaticogastrostomy in Malignant Biliary Obstruction
Published on: March 25, 2022
Endoscopic ultrasound-guided biliary drainage is cost-effective for treatment of malignant distal biliary obstruction
Noppachai Siranart1,2, Patavee Pajareya3, Steven N Steinway4,5
1Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA.
Background:
Endoscopic ultrasound (EUS)-guided biliary drainage is a promising alternative for malignant distal biliary obstruction (MDBO) after failed endoscopic retrograde cholangiopancreatography (ERCP). This study evaluates the cost-effectiveness of EUS-guided gallbladder drainage (EUS-GB) and EUS-guided choledochoduodenostomy (EUS-CBD) compared to percutaneous transhepatic biliary drainage (PTBD) in these patients.
Methods:
A decision analysis model compared costs and quality-adjusted life years (QALYs) over two years for patients with MDBO after failed ERCP, undergoing EUS-GB, EUS-CBD, or PTBD. Incremental cost-effectiveness ratios (ICERs) and net monetary benefits (NMBs) were calculated at a willingness-to-pay threshold of $100,000 per QALY. Probabilistic and deterministic sensitivity analyses were performed.
Results:
Both EUS-GB and EUS-CBD were more cost-effective than PTBD. PTBD cost $14,988, EUS-GB cost $14,520 (adding 0.38 QALYs and $37,768 incremental NMB), and EUS-CBD cost $17,694 (adding 0.55 QALYs and $52,171 incremental NMB). Although PTBD had the lowest cost, it was dominated due to fewer QALYs. Results were robust in sensitivity analyses.
Conclusion:
EUS-GB and EUS-CBD are more cost-effective than PTBD for MDBO after failed ERCP. EUS-GB offers similar value to EUS-CBD, potentially with lower reintervention rates. Endoscopic management should be prioritized over PTBD for these patients.
