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

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

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