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Updated: Feb 10, 2026

Endoscopic Ultrasound-Guided Biliary Drainage: Endoscopic Ultrasound-Guided Hepaticogastrostomy in Malignant Biliary Obstruction

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Esfinterotomía durante el drenaje biliar endoscópico en colangitis con coagulopatía inducida por sepsis aumenta el

Yasuhisa Hiroshima¹, Ryota Sagami², Naosuke Kuraoka³

¹Department of Gastroenterology, Faculty of Medicine, Oita University, Oita, Japan.

Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver

|February 8, 2026

Abstracto

Background:

Acute cholangitis (AC) is life-threatening, requiring urgent biliary drainage. Endoscopic biliary drainage (EBD), often combined with endoscopic sphincterotomy (EST), may prevent post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP). However, sepsis-induced coagulopathy (SIC) increases bleeding risk, raising concerns about EST safety.

Aims:

To evaluate the risk of adverse events (AEs) and clinical outcomes associated with EBD with or without EST in patients with AC and SIC.

Methods:

In this retrospective multicentre cohort study, data from enrolled patients were analysed using propensity score matching, and outcomes were compared between EST and non-EST groups. The primary endpoint was the AE rate difference between EBD with and without EST. Secondary endpoints included differences in clinical outcomes.

Results:

Among 238 patients, 72 underwent EST and 166 did not. The AE incidence, particularly bleeding-related (11.1% vs. 0.6%, P<.001), was higher in the EST group (16.7% vs. 1.8%, P<.001) while PEP incidence (4.2% vs. 1.2%, P=.143) did not differ. Propensity score-matched analysis confirmed these findings. Clinical success or 28-day survival rates did not differ significantly.

Conclusion:

EST significantly increases bleeding risk in patients with AC and SIC without reducing PEP incidence or improving clinical outcomes. EBD without EST can minimise bleeding risk while maintaining adequate biliary drainage.

Palabras clave:

Colangitis aguda Coagulopatía Drenaje biliar endoscópico Esfinterotomía endoscópica

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