Efficacy and Safety of Endoscopic Ultrasound‐Guided Biliary Drainage in the Management of Malignant Hilar Biliary Obstruction: A Multicenter Retrospective Cohort Study

Malignant hilar biliary obstruction (MHBO) remains challenging for biliary decompression. Although endoscopic ultrasound‐guided biliary drainage (EUS‐BD) has emerged as an alternative to endoscopic retrograde cholangiopancreatography‐guided BD (ERCP‐BD), evidence regarding EUS‐BD for MHBO is limited. Aims To evaluate the efficacy and safety of EUS‐BD for MHBO. Methods This multicenter retrospective cohort study included patients with MHBO who underwent EUS‐BD at 12 tertiary referral centers between 2012 and 2023. Technical success, clinical success, and procedure‐related adverse events (AEs) were assessed. Multivariable analysis was performed to identify factors associated with clinical failure. Results A total of 141 patients were included. EUS‐BD was performed as primary drainage in 67 patients (47.5%) and as rescue drainage after prior ERCP‐BD in 74 patients (52.5%); in rescue cases, the reported configurations represented only the EUS‐BD component. The overall technical success rate was 98.5% (139/141). Clinical success was achieved in 87.1% (121/139). Among patients who achieved clinical success, the median time to recurrent biliary obstruction was 201 days. Procedure‐related AE occurred in 15 patients (10.6%). Multivariable analysis identified Bismuth type IV strictures (odds ratio [OR], 5.89; 95% confidence interval [95% CI], 1.72–24.3) and EUS‐BD drainage limited to one or two liver segments (OR, 5.11; 95% CI, 1.49–21.2) as factors associated with clinical failure. Conclusions EUS‐BD is a highly feasible and relatively safe option for BD of MHBO in both primary and rescue settings. Bismuth type IV strictures and EUS‐BD drainage limited to one or two liver segments were associated with clinical failure. Trial Registration N/A