Efficacy of primary endoscopic ultrasound-guided biliary drainage with the placement of multiple plastic stents in the management of hepaticojejunostomy stricture: a retrospective, single-center study in Japan

BACKGROUND: Hepaticojejunostomy strictures (HJSS), recurrent cholangitis, and jaundice are major complications of surgical hepaticojejunostomy. Previously, HJSS was managed using percutaneous procedures and balloon enteroscopy-assisted endoscopic retrograde cholangiopancreatography. However, endoscopic ultrasound-biliary drainage (EUS-BD) was recently reported to be an effective salvage procedure. EUS-BD as a primary drainage method using a trans-endosonographically created route (trans-ESCR) has not been previously evaluated. METHODS: We enrolled consecutive patients who underwent EUS-BD for HJSS at the Juntendo University Hospital between March 2017 and December 2022. After ESCR maturation, multiple plastic stents were placed for 1 year with or without cholangioscopic evaluation. We evaluated the technical and clinical success rates, stent removal, HJSS recurrence, and related adverse events. RESULTS: Thirty-seven patients required EUS-guided hepaticogastrostomy/hepaticojejunostomy (n=36/1). The technical and clinical success rates were 94.6% and 100.0%, respectively, and 17% of patients experienced adverse events. Cholangioscopy via ESCR was performed in 19 patients to evaluate the strictures and manage concomitant stones. The success rate of stent removal after multiple stent placements for more than 1 year was 83%. CONCLUSIONS: Primary EUS-BD and trans-ESCR are feasible and effective in the management of HJSS. Further prospective studies are needed to confirm the results of this pilot study.