Efficacy and Safety of Endoscopic Ultrasound-Guided Biliary Drainage in the Management of Malignant Hilar Biliary Obstruction: A Multicenter Retrospective Cohort Study.

Malignant hilar biliary obstruction (MHBO) remains challenging for biliary decompression. Although endoscopic ultrasound-guided biliary drainage (EUS-BD) has emerged as an alternative to endoscopic retrograde cholangiopancreatography-guided BD (ERCP-BD), evidence regarding EUS-BD for MHBO is limited. Aims:To evaluate the efficacy and safety of EUS-BD for MHBO. Methods:This multicenter retrospective cohort study included patients with MHBO who underwent EUS-BD at 12 tertiary referral centers between 2012 and 2023. Technical success, clinical success, and procedure-related adverse events (AEs) were assessed. Multivariable analysis was performed to identify factors associated with clinical failure. Results:A total of 141 patients were included. EUS-BD was performed as primary drainage in 67 patients (47.5%) and as rescue drainage after prior ERCP-BD in 74 patients (52.5%); in rescue cases, the reported configurations represented only the EUS-BD component. The overall technical success rate was 98.5% (139/141). Clinical success was achieved in 87.1% (121/139). Among patients who achieved clinical success, the median time to recurrent biliary obstruction was 201 days. Procedure-related AE occurred in 15 patients (10.6%). Multivariable analysis identified Bismuth type IV strictures (odds ratio [OR], 5.89; 95% confidence interval [95% CI], 1.72-24.3) and EUS-BD drainage limited to one or two liver segments (OR, 5.11; 95% CI, 1.49-21.2) as factors associated with clinical failure. Conclusions:EUS-BD is a highly feasible and relatively safe option for BD of MHBO in both primary and rescue settings. Bismuth type IV strictures and EUS-BD drainage limited to one or two liver segments were associated with clinical failure. Trial Registration:N/A.