Clinical Trial Summary
One of the major roles of interventional EUS is biliary drainage (EUS-BD) as an alternative
to ERCP-based biliary decompression.
In fact, even when performed by expert endoscopists, ERCP-based stenting fails in 5% of
cases. In these cases, standard alternative approaches include surgical bypass and
percutaneous transhepatic cholangiography and biliary drainage (PTBD). However, these
procedures are associated with higher patient discomfort and prolonged hospital stay.
The most diffuse approach for EUS-BD are choledochoduodenostomy (CDS) or hepaticogastrostomy
(HGS). As a matter of fact, since dedicate devices as lumen apposing metal stents (LAMS),
have been adopted for CDS, we have been witnessing the escalation of such procedure.
On the other hand, the diffusion of EUS-HGS is still limited due to the complexity of the
procedure and the lack of dedicated devices. However, recently a dedicated stent was
conceived as asymmetrically covered and shaped in order to have its uncovered, tubular end
into the intrahepatic ducts and the covered, flanged end into the gastric cavity, to reduce
the risk of migration. The developement of such stent could further increase both the
technical feasibility and the clinical outcomes of HGS in order to explore the whole
potential of this procedure and to definitively find its role in biliary drainage algorithm.
