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Updated: Jan 7, 2026
Endoscopic Ultrasound-Guided Biliary Drainage: Endoscopic Ultrasound-Guided Hepaticogastrostomy in Malignant Biliary Obstruction
Published on: March 25, 2022
Adverse Events of EUS-Guided Biliary Drainage for Malignant Biliary Obstruction: A Large Multicenter Study
Masahiro Itonaga1, Takeshi Ogura2, Mamoru Takenaka3
1Second Department of Internal Medicine, Wakayama Medical University, Wakayama, Japan.
Background And Aims:
This study aimed to evaluate adverse events (AEs) for endoscopic ultrasound-guided biliary drainage (EUS-BD) and identify risk factors for early AEs and recurrent biliary obstruction (RBO).
Methods:
A multicenter retrospective study was conducted using a common database of 21 Japanese referral centers.
Results:
A total of 616 patients who underwent EUS-BD, including endoscopic ultrasound-guided choledochoduodenostomy (n = 107), hepaticogastrostomy (n = 487), and hepaticojejunostomy (n = 22), for malignant biliary obstruction were analyzed. Early AEs occurred in 13.6% of patients. Independent risk factors for all AEs included procedure time ≥ 32 min (odds ratio [OR] 1.82) and antiplatelet/anticoagulant use (OR 2.15). A risk factor for peritonitis included electrocautery use (OR 3.87), while bleeding risk was increased with antiplatelet/anticoagulant use (OR 7.19) and performance status > 2 (OR 5.26). The use of plastic stents was associated with a higher risk of a shorter time to RBO. AE and RBO rates did not significantly differ among the three EUS-BD approaches.
Conclusions:
Patients on antiplatelet and/or anticoagulation therapy should be aware of the increased risk of AEs of EUS-BD. In addition, it is important to minimize procedure time, avoid the use of electrocautery, and use a metal stent to prevent early AEs and RBO.
