{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T13:56:54Z","timestamp":1790603814873,"version":"4.1.0"},"reference-count":40,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T00:00:00Z","timestamp":1788912000000},"content-version":"vor","delay-in-days":8,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T00:00:00Z","timestamp":1788220800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["UEG Journal"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Biliary (BO) and gastric outlet obstruction (GOO) frequently complicate pancreatic cancer, often delaying treatment. While EUS\u2010guided gastroenterostomy (EUS\u2010GE) is preferred over duodenal stenting for GOO, the optimal approach for biliary drainage (BD) between EUS\u2010guided choledochoduodenostomy (EUS\u2010CDS) and hepaticogastrostomy (EUS\u2010HGS) remains undefined. This systematic review and meta\u2010analysis aimed to identify the preferred BD strategy in patients undergoing EUS\u2010GE for concurrent GOO and BO.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We searched Medline, Scopus, and EMBASE up to February 2026. Studies were eligible if they reported outcomes of EUS\u2010CDS or EUS\u2010HGS in patients with malignant BO and concomitant GOO treated by EUS\u2010GE. Outcomes included technical and clinical success, stent dysfunction, and adverse events (AEs) analyzed using a random\u2010effects model. Results were reported as relative risks (RRs) with 95% confidence intervals (CIs).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Five studies were included (128 patients; 45.5% female; mean age range 63.0\u201373.0\u00a0years), with 61 undergoing EUS\u2010CDS and 67 undergoing EUS\u2010HGS. Four studies were European, one American, and one prospective. Technical and clinical success rates were similar between groups (RR 0.96, 95% CI 0.83\u20131.11;\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u00a0=\u00a00%; EUS\u2010CDS 94.5% vs. EUS\u2010HGS 96.4%), (RR 1.04, 95% CI 0.92\u20131.19;\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u00a0=\u00a00%; EUS\u2010CDS 96.5% vs. EUS\u2010HGS 89.1%). Stent dysfunction was significantly higher in EUS\u2010CDS (RR 4.42, 95% CI 1.71\u201311.43;\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u00a0=\u00a00%; EUS\u2010CDS 45.1% vs. EUS\u2010HGS 10.9%), while AEs were comparable (RR 1.14, 95% CI 0.24\u20135.50;\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u00a0=\u00a040.8%; EUS\u2010CDS 10.7% vs. EUS\u2010HGS 16.0%).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>EUS\u2010CDS and EUS\u2010HGS appear similarly safe and effective for managing malignant BO with concomitant GOO. However, EUS\u2010CDS carries a significantly higher risk of stent dysfunction, potentially delaying critical cancer treatment.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ueg2.70265","type":"journal-article","created":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T10:33:09Z","timestamp":1788949989000},"source":"Crossref","is-referenced-by-count":0,"title":["EUS\u2010Guided Choledochoduodenostomy Versus Hepaticogastrostomy in Case of Concomitant Gastric Outlet Obstruction Treated by EUS\u2010Guided Gastroenterostomy: A Systematic Review and Meta\u2010Analysis"],"prefix":"10.1002","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3909-9012","authenticated-orcid":false,"given":"Marco","family":"Spadaccini","sequence":"first","affiliation":[{"name":"Department of Biomedical Sciences Humanitas University  Pieve Emanuele Milan Italy"},{"name":"Gastroenterology and Digestive Endoscopy IRCCS Humanitas Research Hospital  Rozzano Milan 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Sciences Humanitas University  Pieve Emanuele Milan Italy"},{"name":"Gastroenterology and Digestive Endoscopy IRCCS Humanitas Research Hospital  Rozzano Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Margherita","family":"Massaro","sequence":"additional","affiliation":[{"name":"Department of Biomedical Sciences Humanitas University  Pieve Emanuele Milan Italy"},{"name":"Gastroenterology and Digestive Endoscopy IRCCS Humanitas Research Hospital  Rozzano Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7280-1761","authenticated-orcid":false,"given":"Giuseppe","family":"Vanella","sequence":"additional","affiliation":[{"name":"Pancreato\u2010Biliary Endoscopy and Endosonography Division Pancreas Translational &amp; Clinical Research Center San Raffaele Scientific Institute IRCCS Vita Salute San Raffaele University  Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-3922-1148","authenticated-orcid":false,"given":"Maria","family":"Terrin","sequence":"additional","affiliation":[{"name":"Gastroenterology and Digestive Endoscopy IRCCS Humanitas Research Hospital  Rozzano Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0715-8233","authenticated-orcid":false,"given":"Matteo","family":"Colombo","sequence":"additional","affiliation":[{"name":"Gastroenterology and Digestive Endoscopy IRCCS Humanitas Research Hospital  Rozzano Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0670-9910","authenticated-orcid":false,"given":"Carlo","family":"Fabbri","sequence":"additional","affiliation":[{"name":"Forl\u00ec\u2010Cesena Hospitals Gastroenterology and Digestive Endoscopy Unit AUSL Romagna  Forl\u00ec\u2010Cesena 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Hepatology and Endoscopy Brigham and Women's Hospital  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1021-0031","authenticated-orcid":false,"given":"Andrea","family":"Anderloni","sequence":"additional","affiliation":[{"name":"Gastroenterology and Endoscopy Unit Fondazione IRCCS Policlinico San Matteo  Pavia Italy"},{"name":"Department of Internal Medicine and Medical Therapeutics University of Pavia  Pavia Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cesare","family":"Hassan","sequence":"additional","affiliation":[{"name":"Department of Biomedical Sciences Humanitas University  Pieve Emanuele Milan Italy"},{"name":"Gastroenterology and Digestive Endoscopy IRCCS Humanitas Research Hospital  Rozzano Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6692-7720","authenticated-orcid":false,"given":"Paolo 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