Endoscopic Ultrasound Guided Hepaticogastrostomy With or Without Antegrade Stenting for Palliation of Malignant Distal Biliary Obstruction: Randomized Controlled Trial

The purpose of this study is to compare the efficacy and safety between EUS-HGAS and EUS-HGS. We hypothesized that EUS-HGAS provides lower recurrent biliary obstruction (RBO) rate but with a comparable safety profile to EUS-HGS.

Inclusion Criteria: * Patients aged 18 years or older with malignant distal biliary obstruction * Failed ERCP * The papilla is inaccessible owing to a surgically altered anatomy or gastric outlet obstruction Exclusion Criteria: * Patients younger than 18 years old * Cancer infiltration of the gastric/duodenal wall within the planned puncture route * Patients with uncorrectable coagulopathy * Patients with unmanageable ascites * Patients with serious comorbidities that prohibited endoscopic management * Patients with pregnancy * Patients who cannot or refuse to provide informed consent