Evaluating the Long-Term Patency and Safety of EUS-guided Hepaticogastrostomy in Biliary Drainage

Aims EUS-guided hepaticogastrostomy (EUS-HGS) has emerged as a valuable alternative in managing biliary drainage for patients with biliary stenosis in cases when conventional endoscopic retrograde cholangiopancreatography (ERCP) fails or is not possible. While short-term outcomes for EUS-HGS have been promising, data on its long-term patency and safety are limited. This study aims to evaluate the long-term patency and safety profile of HGS in patients with biliary obstruction, focusing on stent durability and re-intervention rates.

Methods We conducted a retrospective cohort study involving patients who underwent EUS- HGS for biliary obstruction between March 2020 and October 2023 at a tertiary referral center. Data on demographic profiles, clinical indications, stent type, and outcomes were collected. Key metrics assessed included stent patency duration, need for re-intervention, and complication rates (infection, stent migration, bile leakage, bleeding) over a three-year period.

Results Of 91 patients, 92% had a malignant biliary stenosis, while 8% had a benign one. The mean age of the patients was 65,64±10,60 years old. The indications for EUS-guided drainage varied from surgically altered anatomy 42%, inaccessible papilla due to duodenal stenosis 8%, or additional drainage after ERCP drainage of the right hepatic duct 16%. Of the patients who underwent the procedure during the studied period, 88% maintained stent patency without re-intervention. The median stent patency duration was 6 months, with 12% of patients requiring re-intervention due to stent obstruction. Complications were observed in 6,6% of the patients, primarily minor infections, or cholangitis.

Conclusions EUS-guided hepaticogastrostomy is an effective long-term solution for managing complex biliary obstructions and maintaining long stent patency without re-interventions. Complications were infrequent, primarily involving cholangitis, and the re-intervention rate due to stent obstruction was low. These outcomes promote the EUS-guided HGS as a reliable and sustainable approach for long-term biliary drainage in challenging cases.

Conflicts of Interest

Authors do not have any conflict of interest to disclose.

Publication History

Article published online:
27 March 2025