EUS-guided antegrade stenting versus antegrade stenting with hepaticogastrostomy in patients with unresectable distal malignant biliary obstruction

Endoscopic ultrasound-guided antegrade stenting (EUS-AGS) has emerged as an alternative drainage method for unresectable distal malignant biliary obstruction (DMBO) specifically in patients with surgically altered anatomy (SAA). Recently, some studies have indicated prolonged time to recurrent biliary obstruction (TRBO) and additional AGS during EUS-hepaticogastrostomy (HGS) (HGAS: hepaticogastro-antegrade stenting). However, comparing clinical outcomes between AGS alone and HGAS has not been well studied yet.
Aim: To compare the efficacy and safety of EUS-AGS with EUS-HGAS for DMBO.
Methods: Patients who underwent EUS-AGS or HGAS for DMBO at 3 institutions from January 2012 to October 2024 were enrolled and retrospectively analyzed.
Result: Of the 56 enrolled patients, 35 had EUS-AGS, and 21 had EUS- HGAS. There were no statistical differences in age, sex, performance states, or reasons for EUS-BD. The technical and clinical success rates in the EUS-AGS and EUS-HGAS groups were 100% versus 100% (p=1.00), and 97.1% versus 95.2% (p=1.00), respectively. RBO was recognized in 22.9% versus 19.0% (p=1.00). TRBO and overall survival were 219 days (133-NA) versus NA (74-NA) (p=0.96), and 138 days (69-168) versus 163 days (49-234) (p=0.69). The adverse event rate was 11.4% versus 14.3% (p=1.00). No significant differences occurred in TRBO and overall survival.
Conclusion: Both EUS-AGS and EUS-HGAS for DMBO are effective and relatively safe procedures. Further large-scale studies are required.