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. 2025 Jan;58(1):134-143.
doi: 10.5946/ce.2024.031. Epub 2024 Aug 23.

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

Naminatsu Takahara  1 , Yousuke Nakai  2 , Kensaku Noguchi  1 , Tatsunori Suzuki  1 , Tatsuya Sato  1 , Ryunosuke Hakuta  1 , Kazunaga Ishigaki  3 , Tomotaka Saito  1 , Tsuyoshi Hamada  1   4 , Mitsuhiro Fujishiro  1
Affiliations

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

Naminatsu Takahara et al. Clin Endosc. 2025 Jan.

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.

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

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Conflict of interest statement

Conflicts of Interest

Yousuke Nakai received research grants from Boston Scientific Japan, Fujifilm Corporation, and HOYA Corporation, and honoraria from Boston Scientific Japan, Fujifilm Corporation, Olympus Corporation, and Gadelius Medical. Mitsuhiro Fujishiro received research grants from Olympus Corporation and Fujifilm Corporation, and honoraria from Fujifilm Corporation and Olympus Corporation. The other authors declare no conflict of interest for this article.

Figures

Fig. 1.
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.
Fig. 2.
Fig. 2.
Flow diagram for patient enrollment process.
Fig. 3.
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).
None
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