SynthesisBMC gastroenterology2026
EUS-guided hepaticogastrostomy versus EUS-guided hepaticogastrostomy with antegrade stent placement in patients with unresectable malignant distal biliary obstruction: a meta-analysis of individual patient data.
Synthesis in BMC gastroenterology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundIn patients with malignant biliary obstruction (MBO) where endoscopic retrograde cholangiopancreatography (ERCP) fails, endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) is an important rescue option. This study compared the safety and efficacy of EUS-HGS alone versus EUS-HGS with antegrade stenting (EUS-HGAS).
methodsPubMed, Scopus, and Web of Science were searched for studies comparing EUS-HGS and EUS-HGAS in MBO. Primary outcomes included reintervention rates, and time to recurrent biliary obstruction (TRBO). Secondary outcomes were technical success, clinical success, procedure duration, and adverse events. Individual patient data for TRBO were reconstructed from Kaplan Meier curves and analyzed using restricted mean survival time.
resultsFive observational studies including 451 patients were analyzed (250 EUS-HGS, 201 EUS-HGAS). Reintervention rates were significantly higher in the EUS-HGS group compared with the EUS-HGAS group (RR = 3.00; 95% CI: 1.69-5.34; P = 0.0002). No significant differences were observed between the two groups in terms of technical success, clinical success, procedure duration, overall adverse events, cholangitis, or bleeding. TRBO was significantly longer with EUS-HGAS (mean 651 vs. 227 days; HR = 0.15; 95% CI: 0.03,0.83; P = 0.03), indicating improved stent patency. EUS-HGS was associated with a lower risk of pancreatitis (RR 0.14; 95% CI 0.03-0.60; P=0.008) but a higher risk of bile leakage (RR 5.58; 95% CI 1.03-30.09; P=0.05).
conclusionThis meta-analysis suggests that EUS-HGAS may provide longer time to recurrent biliary obstruction and lower reintervention rates compared with EUS-HGS, while maintaining similar technical and clinical success and procedure time. Overall adverse events were comparable, although bile leakage was more frequent with EUS-HGS and acute pancreatitis with EUS-HGAS. These findings may indicate a potential advantage of EUS-HGAS in terms of stent durability, warranting further studies for confirmation.
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