| Management of hepatocellular carcinoma (HCC) accompanied by biliary stricture is challenging, especially after failed transpapillary endoscopic interventions. EUS-guided biliary drainage (EUS-BD) is a recent alternative technique, but its indication for HCC has not been well studied. We aimed to assess the feasibility of EUS-BD for biliary stricture associated with HCC. We conducted a retrospective analysis of consecutive HCC patients with biliary stricture who, between 2018 and 2023, underwent EUS-BD. A total of 141 transpapillary interventions were performed on 60 patients. Among these, 9 patients (2 females; median age, 73 years) underwent EUS-BD after transpapillary biliary drainage became ineffective. The median number of preceding endoscopic interventions was 2 (range 1-7), and the median Child-Pugh score was 9. EUS-BD was required because transpapillary procedures to select the left intrahepatic bile duct (n=6) or achieve sufficient biliary decompression (n=3) were unsuccessful. Metal stents were placed in all 9 cases. Technical and clinical success rates were 100% and 89%, respectively. No adverse events were noted other than one case of mild peritonitis. The median survival period after EUS-BD was 72 days. Rescue EUS-BD improved clinical success of endoscopic interventions for HCC from 72% to 85%. Although long-term outcomes of EUS-BD cannot be evaluated due to the poor prognosis of HCC, EUS-BD may be feasible alternative after unsuccessful transpapillary interventions, even in HCC patients with cirrhosis. |
