2026 Volume 40 Issue 1 Pages 40-49
We conducted a retrospective analysis comparing outcomes of the plastic stent (PS) and covered self-expanding metal stent (CSEMS) in patients who underwent EUS-guided hepaticogastrostomy (EUS-HGS) for unresectable malignant biliary obstruction (MBO) at our institution. Of 65 patients analyzed (45 in the CSEMS group and 20 in the PS group), the rate of recurrent biliary obstruction (RBO) was significantly lower in the CSEMS group (24%) compared with the PS group (60%) (P = 0.010). The rate of procedure-related adverse events was not significantly different between the two groups. Multivariate analysis identified pre-procedural total bilirubin level <6mg/dL and the use of PS as independent risk factors for RBO. The median time to RBO was significantly longer in the CSEMS group than in the PS group (486 days vs. 170 days, P = 0.007). These findings suggest that CSEMS may be preferable as the first-line choice for EUS-HGS in patients with unresectable MBO.
