Related Experiment Video
Updated: Jan 14, 2026
Endoscopic Ultrasound-Guided Biliary Drainage: Endoscopic Ultrasound-Guided Hepaticogastrostomy in Malignant Biliary Obstruction
Published on: March 25, 2022
Endoscopic biliary drainage outperforms conventional external drainage in pediatric choledochal cyst with severe
Hongxi Guo1, Juan Luo2, Jingjing Chen1
1Department of General Surgery, Wuhan Children's Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China.
Insights
Endoscopic biliary drainage (EBD) is superior to conventional external drainage (CED) for children with choledochal cysts and severe cholangitis. EBD offers faster recovery and fewer complications, making it ideal before definitive surgery.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Biliary Malformations
Background:
- Choledochal cyst (CC) is a common pediatric biliary malformation.
- CC is frequently complicated by severe cholangitis.
- The role of endoscopic biliary drainage (EBD) in pediatric CC with cholangitis is not well-defined.
Purpose of the Study:
- To compare the efficacy and safety of EBD versus conventional external drainage (CED).
- To evaluate EBD as a transitional treatment for pediatric CC complicated by severe cholangitis.
Main Methods:
- Retrospective analysis of clinical data from 59 children with CC and severe cholangitis.
- Comparison of outcomes between CED (n=31) and EBD (n=28) groups.
- Outcomes assessed included operative time, blood loss, hospitalization, pain, complications, and time to radical surgery.
Main Results:
- EBD group showed significantly shorter operative time, less blood loss, and reduced length of stay compared to CED.
- EBD resulted in lower pain scores, fewer complications, and a shorter interval to radical surgery.
- EBD also demonstrated a significantly lower rate of conversion to open surgery.
Conclusions:
- EBD is a less invasive and more effective treatment for pediatric CC with severe cholangitis.
- EBD leads to faster recovery and reduced complications compared to CED.
- EBD is recommended as a preferred transitional therapy before definitive surgical management.
Background:
Choledochal cyst (CC) is a common biliary malformation in children and is often associated with severe cholangitis. While endoscopic biliary drainage (EBD) is well established in adults, its efficacy and safety in children remain unclear. This study aimed to compare the effectiveness and safety of EBD with conventional external drainage (CED) in children with CC complicated by severe cholangitis.
Methods:
Clinical data from children with CC complicated by severe cholangitis who were treated at Wuhan Children's Hospital between January 1, 2013, and January 31, 2025, were retrospectively analyzed. Patients were divided into CED and EBD groups based on the drainage method. Various clinical outcomes were compared between the two groups, including operative time, intraoperative bleeding, postoperative hospitalization duration, pain scores, complication rates, time to radical surgery, conversion to open surgery, and laboratory indices.
Results:
Fifty-nine children (CED: n = 31; EBD: n = 28) were included (12 males and 47 females, with a mean age of 3.21 ± 2.17 years). Compared with CED, the EBD group demonstrated significantly better outcomes, including a shorter operative time (P < 0.001), less blood loss (P < 0.001), reduced length of stay (3.2 vs. 6.5 days, P < 0.001), lower pain scores (2.1 vs. 5.8, P < 0.001), fewer complications (3.57% vs. 25.81%, P = 0.044), shorter radical surgery interval (14 vs. 28 days, P = 0.002), and lower laparotomy conversion rate (3.57% vs. 29.03%, P = 0.024). Both groups demonstrated statistically significant differences in postoperative 24 h reductions of total bilirubin and transaminase levels (P < 0.05).
Conclusions:
In children with CC complicated by severe cholangitis, EBD provides significant advantages over CED. It is less invasive, which leads to faster recovery times and lower complication rates, making it the preferred transitional treatment before definitive surgery.
