Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Jul;58(4):604-611.
doi: 10.5946/ce.2024.218. Epub 2025 Feb 11.

Primary endoscopic ultrasound-guided hepaticogastrostomy for biliary drainage prior to pancreatoduodenectomy: a retrospective study in Japan

Nozomi Okuno  1 , Kazuo Hara  1 , Seiji Natsume  2 , Masataka Okuno  2 , Shin Haba  1 , Tomonari Asano  2 , Takamichi Kuwahara  1 , Hiroki Koda  1 , Yasuhiro Shimizu  2
Affiliations

Primary endoscopic ultrasound-guided hepaticogastrostomy for biliary drainage prior to pancreatoduodenectomy: a retrospective study in Japan

Nozomi Okuno et al. Clin Endosc. 2025 Jul.

Abstract

Background: Malignant lesions of the pancreatic head can cause obstructive jaundice requiring biliary drainage. However, the effect of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis and metal stents on surgical resection remains controversial. This study aimed to investigate the efficacy of primary endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) performed prior to pancreatoduodenectomy, excluding patients with biliary duct cancer.

Methods: We retrospectively analyzed consecutive patients who underwent pancreatoduodenectomy at our institution between January 2019 and December 2022. The patients were divided into three groups: without biliary drainage (n=130), endoscopic biliary stenting (EBS) (n=57), and primary EUS-HGS (n=20).

Results: The positivity rate of the intraoperative bile juice culture was significantly higher in the EBS group (p<0.001). No significant difference was observed among the groups in terms of postoperative adverse events (Clavien-Dindo grade 3 or higher, p=0.784) or the positive rate of peritoneal lavage cytology (p=0.984). Seven patients in the EBS group (12.3%) experienced early adverse events related to biliary drainage (post-ERCP pancreatitis, n=3; acute cholecystitis, n=3; bile duct perforation, n=1), whereas none in the EUS-HGS group experienced adverse events.

Conclusions: Primary EUS-HGS is technically feasible as a preoperative procedure and has no short-term postoperative disadvantages.

Keywords: Endosonography; Obstructive jaundice; Pancreaticoduodenectomy; Preoperative care.

PubMed Disclaimer

Conflict of interest statement

Conflicts of Interest

The authors have no potential conflicts of interest.

Figures

Fig. 1.
Fig. 1.
Flowchart of patients who underwent pancreatoduodenectomy at our institution, excluding those with bile duct cancer. a)Excluding patients with bile duct cancer. b)Converted from endoscopic biliary stenting (EBS) to endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS). PTBD, percutaneous biliary drainage.
Fig. 2.
Fig. 2.
Kaplan-Meier curves for time to biliary obstruction in endoscopic biliary stenting (EBS) (solid line) and endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) (broken line).
None
See this image and copyright information in PMC

References

    1. van der Gaag NA, Rauws EA, van Eijck CH, et al. Preoperative biliary drainage for cancer of the head of the pancreas. N Engl J Med. 2010;362:129–137. - PubMed
    1. Gao Z, Wang J, Shen S, et al. The impact of preoperative biliary drainage on postoperative outcomes in patients with malignant obstructive jaundice: a retrospective analysis of 290 consecutive cases at a single medical center. World J Surg Oncol. 2022;20:7. - PMC - PubMed
    1. Matsumoto K, Noma H, Fujita K, et al. Prognostic factors for severe-to-fatal post-endoscopic retrograde cholangiopancreatography pancreatitis: a multicenter prospective cohort study. J Clin Med. 2024;13:1135. - PMC - PubMed
    1. Park DH, Jang JW, Lee SS, et al. EUS-guided biliary drainage with transluminal stenting after failed ERCP: predictors of adverse events and long-term results. Gastrointest Endosc. 2011;74:1276–1284. - PubMed
    1. Okuno N, Hara K, Mizuno N, et al. Efficacy of the 6-mm fully covered self-expandable metal stent during endoscopic ultrasound-guided hepaticogastrostomy as a primary biliary drainage for the cases estimated difficult endoscopic retrograde cholangiopancreatography: a prospective clinical study. J Gastroenterol Hepatol. 2018;33:1413–1421. - PubMed

LinkOut - more resources