Endoscopic Ultrasound‐Guided Bilateral Stent‐in‐Stent Deployment With Hepaticoenterostomy in patients With Malignant Hilar Biliary Obstruction

BACKGROUND: Endoscopic ultrasound-guided biliary drainage (EUS-BD) has become a popular alternative for patients in whom performing endoscopic retrograde cholangiopancreatography (ERCP) is difficult; however, EUS-BD for malignant hilar biliary obstruction (MHBO) remains controversial, particularly for bilateral drainage. This study aimed to examine the efficacy of EUS-guided bilateral stent-in-stent deployment (EUS-SIS) in patients with unresectable MHBO. METHODS: This retrospective study investigated consecutive patients with MHBO in whom ERCP was difficult or failed and EUS-SIS was attempted. A total of 20 patients met the inclusion criteria. Study outcomes included technical and clinical success, recurrent biliary obstruction (RBO), and other adverse events associated with EUS-SIS. RESULTS: The technical success rate of EUS-SIS was 75% (15/20). The main reason for the technical failure was the inability to advance the guidewire into the contralateral intrahepatic bile duct. Clinical success was achieved in all technically successful cases. The early and late adverse event rates were 5% (1/20) and 7% (1/15), respectively. The incidence rate of RBO was 33% (5/15), and reintervention for RBO via the EUS-BD route was successful in all cases. The median time to RBO was 161 days, and the median overall survival was 191 days. CONCLUSIONS: EUS-SIS was promising for performing bilateral drainage when ERCP failed in patients with MHBO. However, to establish this technique as a widely accepted treatment, its technical success rate needs to be improved.