ESGE Days 2025 - oral presentations | EUS-guided anastomosis: Let's get connected again I Episode 5
EUS guided Hepaticogastrostomy versus ERCP and SEMS placement within SEMS as reintervention in patients with blocked biliary metal endoprosthesis
COURSE
Series: ESGE Days 2025 - oral presentations
Season: EUS-guided anastomosis: Let's get connected again
Episode 5 of 5: EUS guided Hepaticogastrostomy versus ERCP and SEMS placement within SEMS as reintervention in patients with blocked biliary metal endoprosthesis
SPEAKERS
Dr. Sridhar Sundaram
DESCRIPTION
This study compares endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) with stent-within-stent (SWS) placement as a reintervention for blocked biliary metal endoprostheses in patients with pancreaticobiliary malignancies. A retrospective review analyzed cases where either technique was used, with technical success achieved in all procedures and no major complications reported. While EUS-HGS showed slightly better functional success, the need for reintervention, reintervention-free survival, and overall survival were similar between both approaches. The findings indicate that EUS-HGS does not offer a clear advantage over SWS for managing blocked biliary stents.
LEARNING OBJECTIVES
EUS-HGS, ERCP and SEMS
RELATED DOCUMENTS
- ESGE Guidelines
- Therapeutic endoscopic ultrasound: European Society of Gastrointestinal Endoscopy (ESGE) Guideline
- Endoscopic tissue sampling – Part 1: Upper gastrointestinal and hepatopancreatobiliary tracts. European Society of Gastrointestinal Endoscopy (ESGE) Guideline
- Indications, results, and clinical impact of endoscopic ultrasound (EUS)-guided sampling in gastroenterology: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline – Updated January 2017
- Endoscopic treatment of chronic pancreatitis: European Society of Gastrointestinal Endoscopy (ESGE) Guideline – Updated August 2018
Recommendations:
ESGE Days 2025 - oral presentations | EUS-guided anastomosis: Let's get connected again | Episode 4
EUS-guided Hepaticogastrostomy using a novel dedicated partially covered stent in Patients with Malignant Biliary Obstruction (EPSILON); a prospective cohort study (00:09:15)
Description
The study presented assesses the safety and feasibility of endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) using a dedicated partially covered stent with anti-migration flaps (Giobor stent) for patients with inoperable malignant biliary obstructions. Conducted as a prospective single-center study, it included patients with duodenal obstruction, altered anatomy, or failed drainage of the left hepatic duct. The procedure was technically successful in most cases, with minimal serious adverse events. Some patients required re-intervention due to cholangitis or stent migration, but these issues were successfully managed endoscopically. Clinical success was achieved in nearly all cases with follow-up. The findings suggest that EUS-HGS with this specialized stent offers a safe and effective option for biliary drainage, reducing risks associated with conventional techniques.
