BACKGROUND AND OBJECTIVES: Recurrence of benign bilioenteric anastomotic strictures (BAS) is common after enteroscopy-assisted endoscopic retrograde cholangiopancreatography (ERCP), percutaneous intervention, or EUS-guided antegrade intervention (EUS-AI). This study evaluated the long-term outcomes of EUS-AI with transmural and transanastomotic stenting (TAS) following EUS-guided hepaticogastrostomy (HGS) in BAS. METHODS: Consecutive patients with BAS undergoing EUS-AI with or without TAS after failed deep enteroscopy between January 2016 and June 2023 were retrospectively analyzed. The primary outcome was BAS recurrence rate after TAS removal
secondary outcomes included technical success of AI, on demand endoscopic procedure (DP) rate, the time to DP, and adverse events. RESULTS: Among 38 patients who underwent EUS-HGS, EUS-AI succeeded in 34 (89.5%), and 28 (73.7%) proceeded to TAS. The median follow-up duration for 28 patients with TAS was 53.4 months (IQR, 22.8-85.2). During TAS placement without regular stent change, DP occurred in 43% (12/28) at a median time of 23 months. The 1-year procedure-free rate was 81.2%. After TAS removal ( CONCLUSION: EUS-AI with indwelling TAS, without regular stent change, may offer promising long-term outcomes for BAS by reducing recurrence.