Comparison of Two Partially Covered Metal Stents for Endoscopic Ultrasound‐guided Hepaticogastrostomy: A Multi‐Center Retrospective Study

Abstract

ABSTRACT Objectives Endoscopic ultrasound‐guided hepaticogastrostomy (EUS‐HGS) is an alternative biliary drainage method after failed endoscopic retrograde cholangiopancreatography. Nevertheless, it is associated with adverse events (AEs), including peritonitis and stent migration. The influence of metallic stent (MS) design characteristics, including axial force (AF), on the safety and efficacy of EUS‐HGS remains unclear. Methods This multicenter retrospective study included patients with unresectable malignant biliary obstruction who underwent EUS‐HGS using either a high‐AF MS (Niti‐S biliary S‐type) or a low‐AF MS (EGIS biliary) between January 2019 and December 2022. Propensity score matching was performed in a 1:2 ratio. Outcomes included clinical success, early and late non‐recurrent biliary obstruction (non‐RBO) AEs, RBO, time to RBO (TRBO), and overall survival (OS). Results After matching, 27 patients in the high‐AF group and 54 in the low‐AF group were analyzed. Clinical success, RBO rate, TRBO, OS, and late non‐RBO AE rates were similar between groups. However, early non‐RBO AEs were more frequent in the high‐AF group (37% vs. 13%, p = 0.02). Conclusions Of the two partially covered MSs evaluated, the EGIS biliary stent demonstrated fewer early non‐RBO AEs after EUS‐HGS.