Antegrade stenting followed by EUS-guided hepaticogastrostomy extends time to recurrent biliary obstruction in patients with unresectable malignant distal biliary obstruction.

Endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) is associated with higher rates of adverse events and recurrent biliary obstruction compared to antegrade stenting followed by EUS-HGS (EUS-HGAS) in patients with malignant distal biliary obstruction. However, EUS-HGAS significantly extends the time to recurrent biliary obstruction, potentially benefiting patients with longer life expectancy.