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CC BY 4.0 · Endosc Int Open 2025; 13: a25658206
DOI: 10.1055/a-2565-8206
Original article

Novel approach to bilateral biliary drainage: EUS-guided hepaticoduodenodenostomy plus hepaticogastrostomy in malignant hilar biliary obstruction

Autoren

  • Susumu Hijioka 

    1   Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital, Chuo-ku, Japan

  • Yoshikuni Nagashio

    1   Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital, Chuo-ku, Japan

  • Yuta Maruki

    1   Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital, Chuo-ku, Japan

  • Shota Harai

    1   Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital, Chuo-ku, Japan

  • Daiki Agarie

    1   Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital, Chuo-ku, Japan

  • Daiki Yamashige 

    1   Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital, Chuo-ku, Japan

  • Kohei Okamoto

    1   Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital, Chuo-ku, Japan

  • Shin Yagi

    1   Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital, Chuo-ku, Japan

  • Soma Fukuda 

    1   Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital, Chuo-ku, Japan

  • Yasuhiro Komori 

    1   Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital, Chuo-ku, Japan

  • Masaru Kuwada

    1   Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital, Chuo-ku, Japan

  • Yutaka Saito

    2   Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan

  • Takuji Okusaka

    1   Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital, Chuo-ku, Japan

Gefördert durch: The National Cancer Center Research and Development Fund 2022-A-16
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Graphical Abstract

Abstract

Background and study aims

Biliary drainage for unresectable malignant hilar biliary obstruction (MHBO) can be technically challenging; therefore, there is a requirement for new treatment methods. This study evaluated the efficacy and safety of a novel bilateral drainage method—endoscopic ultrasound-guided hepaticoduodenostomy plus hepaticogastrostomy (EUS-HDGS)—which combines EUS-guided hepaticoduodenostomy (EUS-HDS) and hepaticogastrostomy (EUS-HGS).

Patients and methods

From 2018 to 2024, we reviewed eight cases of EUS-HDGS from 749 EUS procedures. Both EUS-HDS and EUS-HGS were performed simultaneously. The study outcomes were technical success, clinical success (reduced bilirubin levels or improved cholangitis within 14 days), and adverse events.

Results

Technical success was achieved in 87.5% cases (7/8), whereas clinical success was observed in 75.0% (6/8). Mild peritonitis occurred in 25% of patients (2/8) and 75.0% of patients (6/8) experienced recurrent biliary obstruction, with successful reintervention achieved in all cases. Median stent patency period was 90 days (95% confidence interval: 47.0–133).

Conclusions

EUS-HDGS is a safe and effective drainage method for treating refractory MHBO and has potential as a viable treatment option.

Graphical Abstract

Keywords

Endoscopic ultrasonography - Biliary tract - Intervention EUS - Pancreatobiliary (ERCP/PTCD) - Strictures


Publikationsverlauf

Eingereicht: 21. November 2024

Angenommen nach Revision: 27. Februar 2025

Accepted Manuscript online:
24. März 2025

Artikel online veröffentlicht:
15. April 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).

Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

Bibliographical Record
Susumu Hijioka, Yoshikuni Nagashio, Yuta Maruki, Shota Harai, Daiki Agarie, Daiki Yamashige, Kohei Okamoto, Shin Yagi, Soma Fukuda, Yasuhiro Komori, Masaru Kuwada, Yutaka Saito, Takuji Okusaka. Novel approach to bilateral biliary drainage: EUS-guided hepaticoduodenodenostomy plus hepaticogastrostomy in malignant hilar biliary obstruction. Endosc Int Open 2025; 13: a25658206.
DOI: 10.1055/a-2565-8206
 

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