Endoscopic Ultrasound-Guided Hepaticogastrostomy With Plastic Stents in Comparison to Transpapillary Drainage With...

Endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) is usually performed for unresectable malignant distal biliary obstruction (MDBO) when endoscopic retrograde cholangiopancreatography-guided biliary stenting with fully covered self-expandable metallic stents (EBS-MSs) fails. We aimed to clarify the clinical outcomes of EUS-HGS with plastic stents (HGS-PSs) compared to EBS-MS.

We retrospectively reviewed patients who underwent either HGS-PS with or without antegrade stenting using MS (AS-MS) or EBS-MS as initial biliary drainage for unresectable MDBO between January 2017 and July 2024.

A total of 27 patients were included in the HGS-PS group, and 128 patients were included in the EBS-MS group. Median procedure time was significantly shorter for the HGS-PS group (24 vs. 39 min, p < 0.001), and the incidence of adverse events was comparable (22% vs. 32%, p = 0.365). The HGS-PS group had a significantly higher recurrent biliary obstruction (RBO) rate (48% vs. 26%, p = 0.002) and shorter time to RBO (TRBO) (169 vs. 341 days, p = 0.001). After propensity score matching, no significant differences were observed in either the RBO rate or TRBO. Subgroup analyses showed that TRBO was comparable between the HGS-PS with AS-MS and EBS-MS groups (273 vs. 341 days, p = 0.609).

Although TRBO tended to be shorter for HGS-PS compared to EBS-MS, the addition of AS-MS to HGS-PS led to comparable TRBO, suggesting that this combination may be a viable alternative.

Clinical Trial Registration: The authors have confirmed clinical trial registration is not needed for this submission.