Aims Biliary drainage through EUS-guided hepaticogastrostomy has proven effective in patients
with malignant biliary obstruction (MBO) when ERCP is unsuccessful or unfeasible.
The technique is still under standardization, and there is no consensus on the type
of stent to use. Traditionally, partially covered self-expanding metal stents (PC-SEMS)
have been preferred due to lower migration rates. However, occlusion rates due to
ingrowth as high as 27% have been reported. Fully covered SEMS (FC-SEMS) with anti-migration
flaps may address stent occlusion while minimizing migration risks.
Methods This multicenter retrospective study analyzed EUS-guided hepaticogastrostomies performed
between 2017 and 2024 in three tertiary centers as palliative drainage for patients
with MBO unsuitable for ERCP. Demographic, procedural, and follow-up data were collected.
The primary outcome was the rate of biliary reobstruction (RBO), defined as jaundice
or biliary infection due to sludge or ingrowth, and the need for biliary reintervention
(BRI). Statistical analysis included uni/multivariate and survival analysis comparing
FC-SEMS and PC-SEMS [1]
[2]
[3].
Results Data were obtained for 162 patients (52.8% male, mean age 71.13±20.51 years). The
most frequent cause of MBO was pancreatic cancer (60.93%), followed by distal cholangiocarcinoma
(15.89%). The primary reasons for hepaticogastrostomy were duodenal infiltration (40.44%)
and postsurgical anatomy (22.79%). Baseline variables showed no significant differences
between patients receiving FC-SEMS and PC-SEMS (50.93% vs. 49.07%, respectively).
The clinical success rate was 83.75%, with an adverse event rate of 19.25%, most of
which were mild to moderate (AGREE II: 43.75%). Overall, the RBO rate was 16.15% during
a mean follow-up of 79 days (IQR 31–195)***. Among patients with RBO, 69.57% required
intervention, achieving a clinical success rate of 87.4%. In comparative analysis,
no significant differences in RBO rates were found between FC-SEMS and PC-SEMS after
adjusting for technical variables (dilation, anchoring with pigtails, etc.). Survival
analysis also revealed no differences in stent patency (p=0.1).
Conclusions EUS-guided hepaticogastrostomy with SEMS is a safe medium-term biliary drainage method,
achieving stent patency above 80% with effective resolution of obstructions. The choice
between FC-SEMS and PC-SEMS does not significantly impact stent patency, suggesting
that selection should rely on the endoscopist’s expertise and available resources.
