Endoscopy international open · 2025
Novel approach to bilateral biliary drainage: EUS-guided hepaticoduodenodenostomy plus hepaticogastrostomy in malignant hilar biliary obstruction.
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Hijioka Susumu, Nagashio Yoshikuni, Maruki Yuta, Harai Shota, Agarie Daiki, Yamashige Daiki, Okamoto Kohei, Yagi Shin, Fukuda Soma, Komori Yasuhiro, Kuwada Masaru, Saito Yutaka, Okusaka Takuji
Аннотация
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.
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.