Comparative outcomes of hepaticojejunostomy versus ERCP-Guided metal stenting for malignant distal biliary obstruction: a single-center retrospective study

Malignant distal biliary obstruction (MDBO) is commonly managed by internal drainage with ERCP-guided self-expandable metal stents (ERCP-SEMS) or surgical hepaticojejunostomy (HJ), yet contemporary SEMS-only, patient-centered comparisons focusing on time to recurrent jaundice are scarce. To compare HJ versus ERCP-SEMS in MDBO, with a primary focus on time to recurrent jaundice. We conducted a single-center retrospective cohort of consecutive MDBO patients undergoing palliative biliary decompression (February 2013–August 2021). Groups were defined by the first modality achieving effective internal drainage. The primary endpoint was time to recurrent jaundice (interval to repeat biliary intervention). Secondary endpoints were length of stay (LOS), 30-day complications, and overall survival (OS). Among 171 patients (HJ, n = 107; ERCP-SEMS, n = 64) with broadly comparable baselines, ERCP-SEMS yielded a shorter LOS (6.67 ± 4.02 vs. 9.56 ± 5.38 days; P < 0.001). Thirty-day complication rates were similar (21.9% vs. 21.5%), but profiles differed (more post-ERCP pancreatitis vs. more biliary fistula after HJ). Median follow-up was 12.8 months; OS did not differ (11.6 vs. 13.3 months; P = 0.978). Time to recurrent jaundice was significantly longer after HJ than ERCP-SEMS (events 3/107 vs. 8/64; P = 0.007). Both strategies effectively relieve jaundice with comparable survival. ERCP-SEMS offers superior short-term efficiency (shorter hospitalization), whereas HJ provides mid-term durability (prolonged jaundice-free interval). Management should individualize this trade-off within a multidisciplinary framework.