Esophagogastric junction marking clip placement during endoscopic ultrasound-guided hepaticogastrostomy: a...

Endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) is a crucial biliary drainage technique but is associated with a risk of unintentional transesophageal puncture, which can cause serious adverse events. This study aimed to evaluate whether routine placement of a marking clip at the esophagogastric junction (EGJ) reduces the incidence of transesophageal puncture during EUS-HGS.

This retrospective single-center study included consecutive patients who underwent EUS-HGS with routine placement of an EGJ marking clip between March 2019 and February 2026. Transesophageal puncture was defined as fluoroscopic confirmation of esophageal-side puncture relative to the deployment of the clip or final stent within the esophagus. Technical success, clinical success, and adverse events were also assessed. Endoscopists were classified as beginners or experts based on prior experience with EUS-guided biliary drainage.

In total, 49 patients underwent EUS-HGS with EGJ marking clip placement. No cases of transesophageal puncture were observed, despite 87.8% of the procedures being performed by beginner endoscopists. The technical and clinical success rates were both 98.0%. Procedure-related adverse events occurred in 2 patients (4.1%).

Routine EGJ marking clip placement during EUS-HGS may help avoid transesophageal puncture and achieve high technical and clinical success rates. This simple technique may improve procedural safety, particularly during the early learning phase of EUS-HGS, without requiring specialized equipment.