Utility of endoscopic ultrasound-guided hepaticoduodenostomy for intrahepatic bile duct drainage: a multicenter retrospective study in western Japan

Background : There are several biliary drainage procedures for biliary strictures, including endoscopic ultrasound-guided hepaticoduodenostomy (EUS-HDS). However, only a few studies have investigated the technical and clinical success of this procedure with a small number of cases at single high-volume centers. Objective: This multicenter, non-controlled, retrospective study evaluated the safety and efficacy of EUS-HDS for intrahepatic bile duct drainage. Methods : Consecutive patients who underwent EUS-HDS at one of 12 Japanese referral centers between January 2010 and December 2024 were enrolled. The primary endpoint was clinical success. The secondary endpoints were technical success, stent patency, and complications. Results : A total of 35 eligible patients were analyzed. Perihilar biliary stenosis was observed in 32 of 35 patients (91.4%) and right posterior sectoral bile ducts were targeted by EUS-HDS in 28 of 35 patients (80.0%). Technical success was achieved in 31 of 35 patients (88.6%) and clinical success was achieved in 24 of 31 patients (77.4%) according to per-protocol analysis. Median stent patency was 285 (6–999) days. An early procedural adverse event (mild peritonitis) occurred in one case. Patency did not significantly differ between plastic and metal stents (P=0.117). In multivariable analysis, less severe than mild cholangitis (P=0.073) and biliary stent deployment before EUS-HDS (P=0.065) tended to predict clinical effectiveness. Conclusions : EUS-HDS may be a feasible and effective treatment, especially for cases with some degree of controlled cholangitis achieved by adequate biliary drainage other than bile ducts targeted by EUS-HDS.