Safety and efficacy of primary endoscopic ultrasound-guided hepaticogastrostomy in older patients: a retrospective study in Japan.

Abstract

Background/Aims Although endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) has been reported to have favorable outcomes, it is associated with a risk of severe adverse events. Despite the increasing frequency of EUS-HGS use in older patients, its safety and efficacy in this population have not been sufficiently evaluated. Methods We retrospectively analyzed 209 patients who underwent EUS-HGS for malignant distal biliary obstruction or Bismuth type I hilar biliary obstruction at our institution between April 2017 and October 2025. Patients were classified into an older group (group O, aged ≥75 years; n=54) or a non-older group (group non-O, aged <75 years; n=155). Patient characteristics and clinical outcomes were compared. Results The median age was 79 years (range, 75-91 years) in group O and 64 years (range, 33-74 years) in the non-O group. Serum creatinine levels (p=0.004) and the rate of antithrombotic agent use (p<0.001) were significantly higher in group O. No significant differences were observed regarding technical success rates (96.3% vs. 93.5%), clinical success rates (94.2% vs. 94.5%), or the incidence of early adverse events (≤14 days; 5.56% vs. 9.68%, p=0.57). Conclusions Our findings suggest that EUS-HGS is a feasible treatment option for older patients, achieving outcomes comparable to those of non-older patients.