When endoscopic retrograde cholangiopancreatography (ERCP) fails to achieve effective biliary drainage in patients with advanced malignant biliary obstruction, interventional endoscopy offers increasingly reliable therapeutic alternatives.

A study conducted at Hospital San Juan de Dios in Costa Rica highlights the value of Endoscopic Ultrasound-Guided Hepaticogastrostomy (EUS-HGS) as a rescue biliary drainage technique following failed ERCP, demonstrating encouraging results in terms of efficacy and safety.

The Study

The retrospective analysis included 20 consecutive patients who underwent EUS-HGS between April 2023 and March 2024.

The primary objective was to evaluate the technical feasibility, clinical effectiveness, and safety of EUS-HGS in patients with unresectable malignant biliary obstruction after unsuccessful ERCP.

Promising Results

The study reported outstanding outcomes:

• 100% technical success
• 95% clinical success
• Average procedure time of only 18 minutes
• No major complications or procedure-related mortality
• Only mild adverse events in 15% of patients, limited to abdominal pain and minor bleeding

These findings reinforce the role of EUS-HGS as a safe and effective therapeutic option for complex biliary obstruction when conventional ERCP is unsuccessful.

The Growing Role of Interventional Endoscopy

Advances in therapeutic endoscopic ultrasound continue to expand the treatment options available for patients with complex biliary diseases.

Procedures such as EUS-guided hepaticogastrostomy make it possible to manage challenging clinical scenarios that previously required more invasive approaches, offering patients safer, faster, and more effective minimally invasive treatments.

At Euromedical, we are committed to supporting healthcare professionals by providing innovative endoscopic technologies and promoting continuous medical education. Studies like this further demonstrate how technological innovation and clinical expertise are driving the future of interventional endoscopy.