Risk Factors for Peritonitis Associated With Endoscopic Ultrasound-guided Hepaticogastrostomy

Endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) is an alternative therapeutic option for unsuccessful endoscopic retrograde cholangiopancreatography in patients with malignant biliary obstruction. Procedure-related adverse events (AEs), such as bile leakage and peritonitis, can lead to prolonged hospitalization and delay the initiation of chemotherapy for underlying malignancies. This study aimed to identify factors associated with the development of peritonitis following EUS-HGS.

Consecutive patients who underwent initial EUS-HGS between July 2016 and November 2022 were retrospectively evaluated. We assessed the preprocedural characteristics (cholangitis and duodenal invasion) and intraprocedural technical factors (small bile duct diameter, short hepatic parenchymal distance at puncture, antegrade stenting, and the use of a plastic stent for HGS). Multivariate logistic regression analysis was conducted to evaluate the factors associated with peritonitis after EUS-HGS.

A total of 188 patients were included. The cause of biliary obstruction was malignancy in 96% of the cases, with the majority being pancreatic cancer. The rate of early AEs was 15% and included peritonitis (7%), pancreatitis (3%), cholangitis (3%), cholecystitis (1%), and bleeding (1%). Multivariable logistic regression analysis revealed that the diameter of a punctured bile duct ≤3 mm (odds ratio, 4.0; 95% confidence interval, 1.1-15; p = 0.039) independently increased the risk of peritonitis after EUS-HGS.

A punctured bile duct diameter of ≤3 mm was identified as a significant independent risk factor for the development of peritonitis after EUS-HGS. Trial Registration: N/A.