Endoscopic ultrasound-guided hepaticogastrostomy and endoscopic retrograde cholangiopancreatography-guided biliary drainage for distal malignant biliary obstruction due to pancreatic cancer with asymptomatic duodenal invasion: a retrospective, single-center study in Japan
- Author:
Naminatsu TAKAHARA
1
;
Yousuke NAKAI
;
Kensaku NOGUCHI
;
Tatsunori SUZUKI
;
Tatsuya SATO
;
Ryunosuke HAKUTA
;
Kazunaga ISHIGAKI
;
Tomotaka SAITO
;
Tsuyoshi HAMADA
;
Mitsuhiro FUJISHIRO
Author Information
- Publication Type:Original Article
- From:Clinical Endoscopy 2025;58(1):134-143
- CountryRepublic of Korea
- Language:English
-
Abstract:
Background/Aims:Duodenal invasion (DI) is a risk factor for early recurrent biliary obstruction (RBO) in endoscopic retrograde cholangiopancreatography-guided biliary drainage (ERCP-BD). Endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) may reduce early RBO in cases of asymptomatic DI, even when ERCP is possible.
Methods:We enrolled 56 patients with pancreatic cancer and asymptomatic DI who underwent EUS-HGS (n=25) or ERCP-BD (n=31). Technical and clinical success, early (<3 months) and overall RBO rates, time to RBO (TRBO), and adverse events were compared between the EUS-HGS and ERCP-BD groups. Risk factors for early RBO were also evaluated.
Results:Baseline characteristics were similar between the groups. Both procedures demonstrated 100% technical and clinical success rates, with a similar incidence of adverse events (48% vs. 39%, p=0.59). While the median TRBO was comparable (5.7 vs. 8.8 months, p=0.60), EUS-HGS was associated with a lower incidence of early RBO compared to ERCP-BD (8% vs. 29%, p=0.09). The major causes of early RBO in ERCP-BD were sludge and food impaction, rarely occurring in EUS-HGS. EUS-HGS was potentially reduced early RBO (odds ratio, 0.32; p=0.07).
Conclusions:EUS-HGS can be a viable option for treating pancreatic cancer with asymptomatic DI.
