EUS-Guided Biliary Drainage Via Hepatogastrostomy Vs. Choledochoduodenostomy Approaches in Malignant Obstructive Jaundice Failed By ERCP: A Comparative Observational Study

Abstract

Background: Endoscopic ultrasound-guided biliary drainage (EUS-BD) is an alternative for biliary decompression in patients with malignant biliary obstruction (MBO) after failed endoscopic retrograde cholangiopancreatography (ERCP). The optimal drainage technique is not yet established.

Aim of the Work: To compare the technical and clinical outcomes and safety of EUS-guided choledochoduodenostomy (CDS) versus hepaticogastrostomy (HGS) in patients with MBO after failed ERCP.

Patients and Methods: This non-randomized comparative observational study included 50 patients with MBO after failed ERCP who underwent CDS (n=25) or HGS (n=25). The technique was selected according to the level of obstruction, duodenal condition, anatomy, and endoscopist expertise. Baseline characteristics, procedure time, technical and clinical success, bilirubin reduction, adverse events, stent patency, reintervention, hospital stay, and survival were compared between the groups.

Results: Technical success was achieved in all patients in both groups, and clinical success in 96% of each group. Total and direct bilirubin decreased significantly after drainage in both groups (p<0.001), with no significant difference between groups. There were no significant differences in procedure time, hospital stay, adverse events (14% overall), reintervention, or survival.

Conclusions: EUS-BD is a relatively safe and effective option after failed ERCP. In this non-randomized study, CDS and HGS had comparable outcomes, although the small sample limits the ability to exclude differences between them. The technique should be tailored to the patient's anatomy and endoscopist expertise.