Clin Endosc.  2025 Jan;58(1):134-143. 10.5946/ce.2024.031.

Endoscopic ultrasound-guided hepaticogastrostomy and endoscopic retrograde cholangiopancreatography-guided biliary drainage for distal malignant biliary obstruction due to pancreatic cancer with asymptomatic duodenal invasion: a retrospective, single-center study in Japan

• Takahara N
• Nakai Y
• Noguchi K
• Suzuki T
• Sato T
• Hakuta R
• Ishigaki K
• Saito T
• Hamada T
• Fujishiro M

• KMID: 2564027
• DOI: http://doi.org/10.5946/ce.2024.031

Abstract

Background/Aims
Duodenal invasion (DI) is a risk factor for early recurrent biliary obstruction (RBO) in endoscopic retrograde cholangiopancreatography-guided biliary drainage (ERCP-BD). Endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) may reduce early RBO in cases of asymptomatic DI, even when ERCP is possible.
Methods
We enrolled 56 patients with pancreatic cancer and asymptomatic DI who underwent EUS-HGS (n=25) or ERCP-BD (n=31). Technical and clinical success, early (<3 months) and overall RBO rates, time to RBO (TRBO), and adverse events were compared between the EUS-HGS and ERCP-BD groups. Risk factors for early RBO were also evaluated.
Results
Baseline characteristics were similar between the groups. Both procedures demonstrated 100% technical and clinical success rates, with a similar incidence of adverse events (48% vs. 39%, p=0.59). While the median TRBO was comparable (5.7 vs. 8.8 months, p=0.60), EUS-HGS was associated with a lower incidence of early RBO compared to ERCP-BD (8% vs. 29%, p=0.09). The major causes of early RBO in ERCP-BD were sludge and food impaction, rarely occurring in EUS-HGS. EUS-HGS was potentially reduced early RBO (odds ratio, 0.32; p=0.07).
Conclusions
EUS-HGS can be a viable option for treating pancreatic cancer with asymptomatic DI.

Keyword

Duodenal invasion; Endoscopic retrograde cholangiopancreatography; Endoscopic ultrasound-guided hepaticogastrostomy; Malignant biliary obstruction; Pancreatic cancer

Figure

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  Fig. 1. Imaging findings of pancreatic cancer with duodenal invasion. (A) Coronal computed tomography image showing pancreatic cancer (*) invading into the duodenum and bile duct (arrowheads and #, respectively). (B) Endoscopic image of the descending portion of the duodenum.

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  Fig. 2. Flow diagram for patient enrollment process.

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  Fig. 3. (A) Kaplan-Meier curves for overall survival in patients with endoscopic ultrasound-guided hapaticogastrostomy (EUS-HGS, solid line) and endoscopic retrograde cholangiopancreatography (ERCP-BD, broken line). (B) Kaplan-Meiers curve for time to recurrent biliary obstruction in patients with EUS-HGS (solid line) and ERCP-BD (broken line).

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