ArticleSurgical endoscopy2026
EUS-guided hepaticogastrostomy using a dedicated partially covered stent in malignant biliary obstruction (EPSILON): a prospective cohort study.
Article in Surgical endoscopy, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
1 citing paper in PubMed.
- Bridging the Gap between Literature and Practice: Nationwide Outcomes of Endoscopic Ultrasound-guided Hepatico-gastrostomy.Endoscopy international open · 2026Article
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Authors and funding
10 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
BACKGROUND AND
aimsEndoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) is an emerging alternative to percutaneous transhepatic biliary drainage (PTBD) in patients with a malignant biliary obstruction, in case of technical failure of endoscopic retrograde cholangiopancreatography (ERCP). However, this procedure is technically challenging, and dedicated stents have only recently become available. This study prospectively evaluated the safety and feasibility of EUS-HGS with a dedicated stent.
methodsThis prospective single-center study included patients with inoperable malignant biliary obstruction that underwent an EUS-HGS. The primary outcome was safety. Technical and clinical success were evaluated as secondary endpoints. We used a partially covered self-expandable metal stent (pcSEMS) (30% uncovered and 70% covered) with anti-migration features.
resultsEUS-HGS was attempted in 28 patients, achieving technical and clinical success rates of 89% (25/28) and 96% (22/23), respectively. Three patients (11%) experienced grade IIIA adverse events (AEs) (all cholangitis) within 30 days: two with undrained right-sided bile ducts requiring percutaneous drainage, and one patient due to blockage of a side branch at the level of the covered part of the stent for which an endoscopic stent exchange was successfully performed. Five patients died < 30 days due to disease progression, none of these patients experienced procedure-related AEs. Six out of the 22 patients with clinical success developed recurrent biliary obstruction after a median of 78 days (IQR 45-108). Obstruction was caused by hyperplasia at the uncovered portion of the stent (n = 3) and due to sludge obstructing the stent (n = 3). Successful re-intervention was performed in all patients.
conclusionsThis prospective study shows that EUS-HGS with a dedicated pcSEMS is feasible and safe. Tissue hyperplasia in the uncovered part of the stent and sludge obstruction may compromise long-term stent patency. Larger, comparative prospective studies are needed to assess optimal stent design and timing of EUS-HGS within the therapeutic algorithm.
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