EUS-guided biliary drainage in patients with surgically altered anatomy: A comparative study with normal anatomy

Objective
To compare the outcomes of endoscopic ultrasound-guided biliary drainage (EUS-BD) in patients with surgically altered anatomy (SAA) and normal anatomy (NA).
Methods
We retrospectively analyzed patients who underwent EUS-BD from June 2020 to January 2025, dividing them into SAA (S group) and NA (N group). Patient backgrounds, procedure details, adverse events, and clinical courses were compared.
Results
A total of 59 patients underwent EUS-BD: 30 in S group, 29 in N group. SAA procedures included Billroth II 3, Roux-en Y gastrectomy 15, pancreaticoduodenectomy 4, gastrojejunostomy 5, right hepatectomy 1, and subtotal esophagectomy with jejunal interposition 1. Technical success was 100% in both groups. Median procedure time was 36.5 min (21-95) in S group, and 38 min (16-125) in N group. Clinical success was 86.7% (26/30) in S group and 96.6% (28/29) in N group. Adverse events occurred in 16.7% (5/30) of S group and 13.8% (4/29) of N group. Stent dysfunction occurred in 16.7% (5/30) of S group (96-day follow-up, range 8-762) and 20.7% (6/29) of N group (61-day follow-up, range 14-530), all requiring stent exchange of additional stent placement.
Conclusion
EUS-BD in S group showed similar technical and clinical success to N group. Procedure time was relatively short, and reintervention for stent dysfunction was feasible. EUS-BD is a promising option for malignant biliary obstruction in S group patients.