Related Experiment Video
Updated: May 7, 2026
Endoscopic Ultrasound-Guided Biliary Drainage: Endoscopic Ultrasound-Guided Hepaticogastrostomy in Malignant Biliary Obstruction
Published on: March 25, 2022
Phase I/II Prospective Study on Endoscopic Ultrasound-Guided Hepaticogastrostomy as Primary Drainage for Unresectable
Tomoki Ogata1, Kazuo Hara1, Nozomi Okuno1
1Department of Gastroenterology Aichi Cancer Center Nagoya Japan.
Objectives:
Various drainage methods have been used for unresectable malignant hilar biliary obstruction (MHBO). However, controlling cholangitis and obstructive jaundice is still challenging. We performed a phase I/II study of endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) as primary drainage for MHBO.
Methods:
This prospective Phase I/II study included 20 patients requiring biliary drainage for MHBO recruited from June 2021 to December 2023. The primary endpoint was safety. The secondary endpoints were clinical efficacy, reintervention methods, and frequency.
Results:
The types of bile duct stenosis were Bismuth type I/II/IIIa/IIIb/IV; 4/1/5/3/7 cases. Fifteen cases (75%) had cholangitis before the EUS-HGS was performed. Technical success rate; 100% (20/20), clinical success rate; 75% (15/20). The four cases in which clinical success was not achieved were Bismuth type IV with cholangitis and obstructive jaundice, and all cases required additional drainage for the right bile duct.Early adverse events were stent migration: one case (severe) and peritonitis: one case (mild).
Conclusions:
The safety of EUS-HGS for the primary drainage of unresectable MHBO is acceptable. Regarding clinical efficacy, based on the results observed in patients with Bismuth type IV obstruction, we acknowledge that further investigation is warranted. Trial Registration: UMIN-CTR: UMIN000047702.
