Comparison of Reintervention Outcomes After Endoscopic Ultrasound-Guided Hepaticogastrostomy According to the Type of Initial Stent

Background/Objectives: The impact of initial stent type on endoscopic reintervention after endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) remains unclear. Methods: We retrospectively evaluated patients with malignant biliary obstruction who developed recurrent biliary obstruction (RBO) after EUS-HGS and underwent reintervention through the endosonographically created route (ESCR). Outcomes were compared according to initial stent type (plastic stent [PS] or self-expandable metallic stent [SEMS]). The association between initial stent type and time to RBO (TRBO) after definitive biliary drainage was assessed using Cox regression and Fine–Gray regression. Results: Of 170 patients who underwent EUS-HGS, 69 were included (PS, n = 23; SEMS, n = 46). The initial reintervention procedure was technically successful in 100% and 95.7% of patients, respectively (p = 0.55). Definitive biliary drainage was technically successful in all 69 patients, while clinical success was achieved in 62 (89.9%). No procedure-related adverse events were observed. Among patients with clinical success, median TRBO was 160 and 140 days in the PS and SEMS groups, respectively. Initial SEMS placement was not significantly associated with TRBO (adjusted hazard ratio, 1.32; 95% confidence interval [CI], 0.55–3.13) or the cumulative incidence of RBO (adjusted subdistribution hazard ratio, 1.67; 95% CI, 0.70–3.97). Conclusions: Endoscopic reintervention through the ESCR was technically feasible after both initial PS and SEMS placement. Initial stent type was not significantly associated with subsequent RBO, although the findings should be interpreted cautiously because of potential temporal confounding and the limited sample size.