{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T10:34:43Z","timestamp":1786703683713,"version":"build-2736575974"},"reference-count":30,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T00:00:00Z","timestamp":1786665600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T00:00:00Z","timestamp":1786665600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["DEN Open"],"published-print":{"date-parts":[[2027,4]]},"abstract":"ABSTRACT<\/jats:title>\n \n Background and Objectives<\/jats:title>\n Endoscopic ultrasound\u2010guided hepaticogastrostomy (EUS\u2010HGS) is an alternative therapeutic option for unsuccessful endoscopic retrograde cholangiopancreatography in patients with malignant biliary obstruction. Procedure\u2010related adverse events (AEs), such as bile leakage and peritonitis, can lead to prolonged hospitalization and delay the initiation of chemotherapy for underlying malignancies. This study aimed to identify factors associated with the development of peritonitis following EUS\u2010HGS.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n Consecutive patients who underwent initial EUS\u2010HGS between July 2016 and November 2022 were retrospectively evaluated. We assessed the preprocedural characteristics (cholangitis and duodenal invasion) and intraprocedural technical factors (small bile duct diameter, short hepatic parenchymal distance at puncture, antegrade stenting, and the use of a plastic stent for HGS). Multivariate logistic regression analysis was conducted to evaluate the factors associated with peritonitis after EUS\u2010HGS.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n A total of 188 patients were included. The cause of biliary obstruction was malignancy in 96% of the cases, with the majority being pancreatic cancer. The rate of early AEs was 15% and included peritonitis (7%), pancreatitis (3%), cholangitis (3%), cholecystitis (1%), and bleeding (1%). Multivariable logistic regression analysis revealed that the diameter of a punctured bile duct \u22643\u00a0mm (odds ratio, 4.0; 95% confidence interval, 1.1\u201315;\n p<\/jats:italic>\n = 0.039) independently increased the risk of peritonitis after EUS\u2010HGS.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n A punctured bile duct diameter of \u22643\u00a0mm was identified as a significant independent risk factor for the development of peritonitis after EUS\u2010HGS.<\/jats:p>\n \n Trial Registration<\/jats:bold>\n : N\/A\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1002\/deo2.70376","type":"journal-article","created":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T10:03:47Z","timestamp":1786701827000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Risk Factors for Peritonitis Associated With Endoscopic Ultrasound\u2010guided Hepaticogastrostomy"],"prefix":"10.1002","volume":"7","author":[{"given":"Junya","family":"Sato","sequence":"first","affiliation":[{"name":"Division of Endoscopy Shizuoka Cancer Center Shizuoka Japan"},{"name":"Department of Gastroenterology St. Marianna University School of Medicine Kawasaki City Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hirotoshi","family":"Ishiwatari","sequence":"additional","affiliation":[{"name":"Division of Pancreatobiliary Medicine Shizuoka Cancer Center Shizuoka Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiroki","family":"Sakamoto","sequence":"additional","affiliation":[{"name":"Division of Pancreatobiliary Medicine Shizuoka Cancer Center Shizuoka Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takuya","family":"Doi","sequence":"additional","affiliation":[{"name":"Division of Pancreatobiliary Medicine Shizuoka Cancer Center Shizuoka Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masahiro","family":"Yamamura","sequence":"additional","affiliation":[{"name":"Division of Pancreatobiliary Medicine Shizuoka Cancer Center Shizuoka Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5074-373X","authenticated-orcid":false,"given":"Kazunori","family":"Takada","sequence":"additional","affiliation":[{"name":"Division of Endoscopy Shizuoka Cancer Center Shizuoka Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masao","family":"Yoshida","sequence":"additional","affiliation":[{"name":"Division of Endoscopy Shizuoka Cancer Center Shizuoka Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sayo","family":"Ito","sequence":"additional","affiliation":[{"name":"Division of Endoscopy Shizuoka Cancer Center Shizuoka Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Noboru","family":"Kawata","sequence":"additional","affiliation":[{"name":"Division of Endoscopy Shizuoka Cancer Center Shizuoka Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9257-5842","authenticated-orcid":false,"given":"Kenichiro","family":"Imai","sequence":"additional","affiliation":[{"name":"Division of Endoscopy Shizuoka Cancer Center Shizuoka Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kinichi","family":"Hotta","sequence":"additional","affiliation":[{"name":"Division of Endoscopy Shizuoka Cancer Center Shizuoka Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiroyuki","family":"Ono","sequence":"additional","affiliation":[{"name":"Division of Endoscopy Shizuoka Cancer Center Shizuoka Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,8,14]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"crossref","first-page":"910","DOI":"10.1055\/a-0659-9864","article-title":"Endoscopic Biliary Stenting: Indications, Choice of Stents, and Results: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline\u2014Updated October 2017","volume":"50","author":"Dumonceau J. M.","year":"2018","journal-title":"Endoscopy"},{"key":"e_1_2_11_3_1","doi-asserted-by":"crossref","first-page":"898","DOI":"10.1055\/s-2001-17324","article-title":"Endoscopic Ultrasound\u2013Guided Bilioduodenal Anastomosis: A New Technique for Biliary Drainage","volume":"33","author":"Giovannini M.","year":"2001","journal-title":"Endoscopy"},{"key":"e_1_2_11_4_1","doi-asserted-by":"crossref","first-page":"575","DOI":"10.1111\/den.13406","article-title":"Comparison of the Efficacy and Safety of Endoscopic Ultrasound\u2013Guided Choledochoduodenostomy and Hepaticogastrostomy for Malignant Distal Biliary Obstruction: Multicenter, Randomized, Clinical Trial","volume":"31","author":"Minaga K.","year":"2019","journal-title":"Digestive Endoscopy"},{"key":"e_1_2_11_5_1","first-page":"163","article-title":"Comparison of the Clinical Impact of Endoscopic Ultrasound\u2010Guided Choledochoduodenostomy and Hepaticogastrostomy for Bile Duct Obstruction with Duodenal Obstruction","volume":"48","author":"Ogura T.","year":"2016","journal-title":"Endoscopy"},{"key":"e_1_2_11_6_1","doi-asserted-by":"crossref","first-page":"419","DOI":"10.1007\/s10620-024-08652-x","article-title":"Feasibility of Endoscopic Ultrasound\u2010Guided Hepaticogastrostomy for Malignant Hilar Biliary Obstruction","volume":"70","author":"Ohno A.","year":"2025","journal-title":"Digestive Diseases and Sciences"},{"key":"e_1_2_11_7_1","article-title":"Novel Approach to Bilateral Biliary Drainage: EUS\u2010Guided Hepaticoduodenostomy plus Hepaticogastrostomy in Malignant Hilar Biliary Obstruction","volume":"13","author":"Hijioka S.","year":"2025","journal-title":"Endoscopy International Open"},{"key":"e_1_2_11_8_1","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1016\/j.vgie.2020.09.011","article-title":"Combined Bridging and Antegrade Stent Placement During Transmural Treatment for Malignant Hilar Biliary Obstruction in a Patient with Surgically Altered Anatomy","volume":"6","author":"Atalla H.","year":"2020","journal-title":"Videogie"},{"key":"e_1_2_11_9_1","doi-asserted-by":"crossref","first-page":"969","DOI":"10.1111\/den.14786","article-title":"Current Status of Preoperative Endoscopic Biliary Drainage for Distal and Hilar Biliary Obstruction","volume":"36","author":"Ishiwatari H.","year":"2024","journal-title":"Digestive Endoscopy"},{"key":"e_1_2_11_10_1","doi-asserted-by":"crossref","first-page":"80","DOI":"10.1097\/MCG.0b013e31828c6822","article-title":"Endoscopic Ultrasound\u2010Assisted Bile Duct Access and Drainage: Multicenter, Long\u2010Term Analysis of Approach, Outcomes, and Complications of a Technique in Evolution","volume":"48","author":"Gupta K.","year":"2014","journal-title":"Journal of Clinical Gastroenterology"},{"key":"e_1_2_11_11_1","doi-asserted-by":"crossref","first-page":"249","DOI":"10.1002\/jhbp.631","article-title":"Clinical Practice Guidelines for Safe Performance of Endoscopic Ultrasound\/Ultrasonography\u2010Guided Biliary Drainage: 2018","volume":"26","author":"Isayama H.","year":"2019","journal-title":"Journal of Hepato\u2010Biliary\u2010Pancreatic Sciences"},{"key":"e_1_2_11_12_1","doi-asserted-by":"crossref","first-page":"1125","DOI":"10.1055\/s-0042-116595","article-title":"Safety and Effectiveness of a Long, Partially Covered Metal Stent for Endoscopic Ultrasound\u2010Guided Hepaticogastrostomy in Patients With Malignant Biliary Obstruction","volume":"48","author":"Nakai Y.","year":"2016","journal-title":"Endoscopy"},{"key":"e_1_2_11_13_1","doi-asserted-by":"crossref","first-page":"703","DOI":"10.1002\/jhbp.1118","article-title":"Endoscopic Ultrasound\u2010Guided Hepaticogastrostomy versus Hepaticogastrostomy With Antegrade Stenting for Malignant Distal Biliary Obstruction","volume":"29","author":"Ishiwatari H.","year":"2022","journal-title":"Journal of Hepato\u2010Biliary\u2010Pancreatic Sciences"},{"key":"e_1_2_11_14_1","doi-asserted-by":"crossref","first-page":"8950","DOI":"10.1007\/s00464-022-09346-z","article-title":"Long\u2010Term Outcomes and Predictors of Adverse Events of EUS\u2010Guided Hepaticogastrostomy for Malignant Biliary Obstruction: Multicenter, Retrospective Study","volume":"36","author":"Cho J. H.","year":"2022","journal-title":"Surgical Endoscopy"},{"key":"e_1_2_11_15_1","doi-asserted-by":"crossref","DOI":"10.1002\/deo2.70145","article-title":"Prevention of Adverse Events in Endoscopic Ultrasound\u2010Guided Biliary Drainage","volume":"6","author":"Ishiwatari H.","year":"2025","journal-title":"DEN Open"},{"key":"e_1_2_11_16_1","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1055\/a-1717-1391","article-title":"Therapeutic Endoscopic Ultrasound: European Society of Gastrointestinal Endoscopy (ESGE) Guideline","volume":"54","author":"Van Der Merwe S. W.","year":"2022","journal-title":"Endoscopy"},{"key":"e_1_2_11_17_1","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1111\/den.14956","article-title":"Metal Stent versus Plastic Stent in Endoscopic Ultrasound\u2010Guided Hepaticogastrostomy for Unresectable Malignant Biliary Obstruction: Large Single\u2010Center Retrospective Comparative Study","volume":"37","author":"Yamashige D.","year":"2025","journal-title":"Digestive Endoscopy"},{"key":"e_1_2_11_18_1","doi-asserted-by":"crossref","first-page":"66","DOI":"10.1016\/j.gie.2024.02.012","article-title":"EUS\u2010Guided Hepaticogastrostomy versus EUS\u2010Guided Hepaticogastrostomy with Antegrade Stent Placement in Patients with Unresectable Malignant Distal Biliary Obstruction: A Propensity Score\u2010Matched Case\u2010Control Study","volume":"100","author":"Ishiwatari H.","year":"2024","journal-title":"Gastrointestinal Endoscopy"},{"key":"e_1_2_11_19_1","doi-asserted-by":"crossref","first-page":"1078","DOI":"10.1016\/j.gie.2021.11.038","article-title":"Novel Classification for Adverse Events in GI Endoscopy: The AGREE Classification","volume":"95","author":"Nass K. J.","year":"2022","journal-title":"Gastrointestinal Endoscopy"},{"key":"e_1_2_11_20_1","doi-asserted-by":"crossref","first-page":"6836","DOI":"10.1007\/s00464-020-08189-w","article-title":"Bile Aspiration during EUS\u2010Guided Hepaticogastrostomy Is Associated With Lower Risk of Postprocedural Adverse Events: A Retrospective Single\u2010Center Study","volume":"35","author":"Ishiwatari H.","year":"2021","journal-title":"Surgical Endoscopy"},{"key":"e_1_2_11_21_1","doi-asserted-by":"crossref","first-page":"515","DOI":"10.1016\/j.gie.2023.06.055","article-title":"Adverse Events with EUS\u2010Guided Biliary Drainage: A Systematic Review and Meta\u2010Analysis","volume":"98","author":"Giri S.","year":"2023","journal-title":"Gastrointestinal Endoscopy"},{"key":"e_1_2_11_22_1","doi-asserted-by":"crossref","first-page":"623","DOI":"10.1016\/j.gie.2020.03.3856","article-title":"Long\u2010Term Outcomes of a Long, Partially Covered Metal Stent for EUS\u2010Guided Hepaticogastrostomy in Patients with Malignant Biliary Obstruction (With Video)","volume":"92","author":"Nakai Y.","year":"2020","journal-title":"Gastrointestinal Endoscopy"},{"key":"e_1_2_11_23_1","doi-asserted-by":"crossref","first-page":"8981","DOI":"10.1007\/s00464-022-09350-3","article-title":"Double Guidewire Technique Stabilization Procedure for Endoscopic Ultrasound\u2010Guided Hepaticogastrostomy Involving Modifying the Guidewire Angle at the Insertion Site","volume":"36","author":"Fujii Y.","year":"2022","journal-title":"Surgical Endoscopy"},{"key":"e_1_2_11_24_1","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1159\/000481233","article-title":"Utility of Endoscopic Ultrasound\u2010Guided Hepaticogastrostomy With Antegrade Stenting for Malignant Biliary Obstruction after Failed Endoscopic Retrograde Cholangiopancreatography","volume":"93","author":"Imai H.","year":"2017","journal-title":"Oncology"},{"key":"e_1_2_11_25_1","doi-asserted-by":"crossref","first-page":"6504","DOI":"10.1007\/s00464-025-12027-2","article-title":"Impact of Preoperative Biliary Drainage on Outcomes of Pancreaticoduodenectomy in Severe Hyperbilirubinemia","volume":"39","author":"Kanani F.","year":"2025","journal-title":"Surgical Endoscopy"},{"key":"e_1_2_11_26_1","doi-asserted-by":"publisher","DOI":"10.1186\/S12957\u2010021\u201002476\u2010Z"},{"key":"e_1_2_11_27_1","first-page":"E77","article-title":"Tardive Peritonitis after the Endoscopic Ultrasound\u2010Guided Hepaticogastrostomy: A Case Report","volume":"24","author":"Yasuhara Y.","year":"2024","journal-title":"DEN Open"},{"key":"e_1_2_11_28_1","doi-asserted-by":"crossref","first-page":"E675","DOI":"10.1055\/a-2364-4298","article-title":"Delayed\u2010Onset Biliary Peritonitis after Endoscopic Ultrasound\u2010Guided Hepaticogastrostomy for Malignant Distal Biliary Obstruction","volume":"56","author":"Sakamoto H.","year":"2024","journal-title":"Endoscopy"},{"key":"e_1_2_11_29_1","doi-asserted-by":"crossref","first-page":"E175","DOI":"10.1055\/s-0041-109083","article-title":"International Multicenter Comparative Trial of Transluminal EUS\u2010Guided Biliary Drainage via Hepatogastrostomy vs. Choledochoduodenostomy Approaches","volume":"4","author":"Khashab M. A.","year":"2016","journal-title":"Endoscopy International Open"},{"key":"e_1_2_11_30_1","doi-asserted-by":"crossref","first-page":"80","DOI":"10.1097\/MCG.0b013e31828c6822","article-title":"Endoscopic Ultrasound\u2010Assisted Bile Duct Access and Drainage: Multicenter Long\u2010Term Analysis of Approach, Outcomes, and Complications of a Technique in Evolution","volume":"48","author":"Gupta K.","year":"2014","journal-title":"Journal of Clinical Gastroenterology"},{"key":"e_1_2_11_31_1","doi-asserted-by":"crossref","first-page":"64","DOI":"10.4103\/EUS-D-21-00251","article-title":"Comparison of Recurrent Biliary Obstruction with the Use of Metal and Plastic Stents in EUS\u2010Guided Biliary Drainage: A Propensity Score\u2010Matched Analysis","volume":"12","author":"Hashimoto S.","year":"2023","journal-title":"Endoscopic Ultrasound"}],"container-title":["DEN Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/deo2.70376","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/deo2.70376","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/deo2.70376","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T10:03:51Z","timestamp":1786701831000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/deo2.70376"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,14]]},"references-count":30,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2027,4]]}},"alternative-id":["10.1002\/deo2.70376"],"URL":"https:\/\/doi.org\/10.1002\/deo2.70376","archive":["Portico"],"relation":{},"ISSN":["2692-4609","2692-4609"],"issn-type":[{"value":"2692-4609","type":"print"},{"value":"2692-4609","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,14]]},"assertion":[{"value":"2026-02-25","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-06-19","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-08-14","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70376"}}