A Porcine Model of Endoscopic Ultrasound-Guided Hepatic Gastrostomy for Malignant Obstructive Jaundice

Current clinical evidence on biliary drainage predominantly focuses on intraoperative outcomes and single-point laboratory assessments, lacking comprehensive longitudinal functional curves and mechanistic insight into the pathways of complications. This study compares endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) with percutaneous transhepatic cholangial drainage (PTCD) in terms of hepatobiliary biochemical decline kinetics during days 0-7, drainage efficiency parameters, inflammatory-endotoxin temporal profiles, and 28-day stent patency-survival endpoints. Twenty-four pigs with surgically induced malignant obstructive jaundice were randomized to the EUS-HGS group (n = 12) or the PTCD group (n = 12). Daily monitoring included total bilirubin (TB), direct bilirubin, alkaline phosphatase, and γ-glutamyltransferase. Drainage volume and bile bilirubin concentrations were recorded daily. C-reactive protein (CRP), interleukin-6 (IL-6), and lipopolysaccharide levels were measured on days 0, 1, 3, 5, and 7, with bile cultures performed on days 0, 3, and 7. The EUS-HGS method demonstrated superior TB half-life (2.3 ± 0.4 vs 3.8 ± 0.6 days; β = -0.42; 95% CI: -0.68 to -0.16; P < 0.001) and a higher drainage efficiency index (5.2 ± 1.1 vs 3.1 ± 0.8 µmol/L/mL; P < 0.001). The 28-day stent patency rate was 91.7% for EUS-HGS and 58.3% for PTCD (hazard ratio = 0.31; 95% CI: 0.12-0.78; P = 0.013). The area under the curve for CRP was significantly lower in the EUS-HGS group (420 ± 95 vs 680 ± 120 mg·day/L; P < 0.001); IL-6 peaked earlier but resolved faster in the EUS-HGS group. Bacterial colonization occurred in 25% of EUS-HGS cases versus 50% of PTCD cases (P = 0.041). The EUS-HGS approach demonstrates superior bilirubin clearance kinetics, enhanced drainage efficiency, reduced inflammatory burden, and improved 28-day patency compared with PTCD, supporting the mechanistic advantages of the transgastric approach.