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Review
. 2019 Nov 28;8(Suppl 1):S35-S39.
doi: 10.4103/eus.eus_47_19. eCollection 2019 Nov.

EUS-guided hepaticogastrostomy

Marc Giovannini  1
Affiliations
Review

EUS-guided hepaticogastrostomy

Marc Giovannini. Endosc Ultrasound. .

Abstract

EUS-guided biliary drainage (BD) is an option to treat obstructive jaundice when ERCP drainage fails. These procedures represent alternatives to surgery and percutaneous transhepatic BD and have been made possible through the continuous development and improvement of EUS scopes and accessories. The development of linear sectorial array EUS scopes in early 1990 brought a new approach to the diagnostic and therapeutic dimensions of echoendoscopy capabilities, opening the possibility to perform puncture over a direct ultrasonographic view. Despite the high success rate and low morbidity of BD obtained by ERCP, difficulty can arise with an ingrown stent tumor, tumor gut compression, periampullary diverticula, and anatomic variation. The EUS-guided technique requires puncture and contrast of the left biliary tree. When performed from the gastric wall, access is obtained through hepatic segment III. Diathermic dilation of the puncturing tract is performed using a 6F cystotome and a plastic or metallic stent. The technical success of hepaticogastrostomy is near 98%, and complications are present in 15%-20% of cases. The most common complications include pneumoperitoneum, bilioperitoneum, infection, and stent dysfunction. To prevent bile leakage, we used a special partially covered stent (70% covered and 30% uncovered). Over the last 15 years, the technique has typically been performed in reference centers, by groups experienced with ERCP. This seems to be a general guideline for safer execution of the procedure.

Keywords: Biliary drainage; EUS; hepaticogastrostomy.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
New therapeutic EUS scope with large working channel (4.0 mm)
Figure 2
Figure 2
EchoTip® Access Needle (Cook medical, Wiston Salem, US)
Figure 3
Figure 3
Hepaticogastrostomy using a GIOBOR stent (Taewong Medical, Seoul, South Korea)
See this image and copyright information in PMC

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