Risk factor of bile leakage associated with EUS-guided biliary drainage/anastomosis (EUS-BD/A)

[Purpose]We investigated the risk factors of Bile leakage (BL) after EUS-BD/A. [Methods] All patients who underwent EUS-BD/A at our hospital from April 2017 to December 2023 were included. Patients with (group A) and without (group B) BL were compared retrospectively. [Results] A total of 272 patients underwent EUS-BD/A ( group A: 16, group B: 256 patients) were analyzed. In univariate analysis of procedural factors, shorter liver parenchymal length (LPL; distance between liver surface and punctured bile duct) (22.6 vs. 30 mm, p<0.001) and Covered SEMS (C-SEMS) placement (5 vs. 141 patients, p=0.046) were significantly associated with BL, and these are significant in multi-variate analysis as well. Risk factors according to the stent type was analyzed in Plastic stent (PS, 109 cases) and C-SEMS (146 cases), respectively. Among PS patients, shorter LPL was associated with BL (20 mm vs. 32.2 mm, p<0.001), and the ROC curve showed 24.4 mm as cu-off value with sensitivity of 86% and specificity of 100%. On the other hand, among C-SEMS cases, migration/deviation of C-SEMS was the greatest risk factor of BL (4 vs. 0 patients, p<0.001). [Conclusions] Short LPL and C-SEMS were the significant risk factors of BL in EUS-BD/A. Keeping longer LPL than 24.4 mm for PS and prevention of migration/deviation for C-SEMS were crucial.