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Updated: Aug 16, 2026
07:44
Endoscopic Ultrasound-Guided Biliary Drainage: Endoscopic Ultrasound-Guided Hepaticogastrostomy in Malignant Biliary Obstruction
Published on: March 25, 2022
Risk Factors for Peritonitis Associated With Endoscopic Ultrasound-guided Hepaticogastrostomy
Junya Sato1,2, Hirotoshi Ishiwatari3, Hiroki Sakamoto3
1Division of Endoscopy Shizuoka Cancer Center Shizuoka Japan.
DEN Open
|August 15, 2026
Summary
A small bile duct diameter (≤3 mm) during endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) significantly increases the risk of peritonitis. This finding helps predict and potentially prevent serious adverse events in patients with malignant biliary obstruction undergoing EUS-HGS.
Area of Science:
- Gastroenterology
- Interventional Endoscopy
- Surgical Oncology
Background:
- Endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) offers an alternative for malignant biliary obstruction when ERCP fails.
- Adverse events like bile leakage and peritonitis can complicate EUS-HGS, delaying cancer treatment.
- Identifying risk factors for peritonitis is crucial for patient management.
Purpose of the Study:
- To identify factors associated with the development of peritonitis following EUS-HGS.
- To analyze preprocedural and intraprocedural variables influencing peritonitis risk.
Main Methods:
- Retrospective evaluation of 188 patients undergoing initial EUS-HGS (July 2016 - November 2022).
- Assessment of preprocedural (cholangitis, duodenal invasion) and technical factors (bile duct diameter, parenchymal distance, stenting type).
- Multivariate logistic regression analysis to determine independent risk factors for peritonitis.
Main Results:
- The overall early adverse event rate was 15%, with peritonitis occurring in 7% of patients.
- Malignancy, primarily pancreatic cancer, was the cause of biliary obstruction in 96% of cases.
- A punctured bile duct diameter ≤3 mm was a significant independent risk factor for peritonitis (OR 4.0, p=0.039).
Conclusions:
- A bile duct diameter ≤3 mm is a significant independent risk factor for peritonitis after EUS-HGS.
- This finding aids in risk stratification and procedural planning for EUS-HGS.
- Minimizing peritonitis risk can improve outcomes for patients with malignant biliary obstruction.
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