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      What You Need to Know Before Performing Endoscopic Ultrasound-guided Hepaticogastrostomy

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          Abstract

          Endoscopic retrograde cholangiopancreatography (ERCP) is the primary treatment modality for bile duct obstruction. When ERCP is unsuccessful, percutaneous transhepatic biliary drainage can be an alternative method. Endoscopic ultrasound-guided biliary drainage (EUS-BD) has emerged as a treatment option for biliary obstruction, especially after ERCP failure. EUS-BD offers transluminal intrahepatic and extrahepatic drainage through a transgastric and transduodenal approach. EUS-guided hepaticogastrostomy (EUS-HGS) is an excellent choice for patients with hilar strictures or those with a surgically altered anatomy. The optimal steps in EUS-HGS are case selection, bile duct visualization, puncture-site selection, wire insertion and manipulation, tract dilation, and stent placement. Caution should be taken at each step to prevent complications. Dedicated devices for EUS-HGS have been developed to improve the technical success rate and reduce complications. This technical review focuses on the essential practical points at each step of EUS-HGS.

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          Consensus guidelines on the optimal management in interventional EUS procedures: results from the Asian EUS group RAND/UCLA expert panel.

          Anthony Y B Teoh, Vinay Dhir, Mitsuhiro Kida … (2018)
          Interventional endoscopic ultrasonography (EUS) procedures are gaining popularity and the most commonly performed procedures include EUS-guided drainage of pancreatic pseudocyst, EUS-guided biliary drainage, EUS-guided pancreatic duct drainage and EUS-guided celiac plexus ablation. The aim of this paper is to formulate a set of practice guidelines addressing various aspects of the above procedures.
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            EUS-cholangio-drainage of the bile duct: report of 4 cases.

            Andrew Niehaus, Thomas Huetteroth, Thomas Leineweber … (2003)
            Endoscopic retrograde cholangiography with stent insertion is an established procedure for palliation of patients with malignant pancreaticobiliary strictures. In some patients, however, placement of a stent by means of a duodenoscope is not possible. Percutaneous transhepatic biliary drainage is an alternative method that has a complication rate of up to 15%. Four cases of successful EUS-guided-cholangio-drainage are presented in which the major papilla could not be cannulated at endoscopic retrograde cholangiography. For puncture of the intrahepatic or extrahepatic bile duct, a modification of the one-step technique for the drainage of pancreatic pseudocysts was used. Stent insertion was successful in 3 of the 4 patients. In these 3 patients cholestasis resolved promptly. EUS-guided cholangio-drainage is a potential alternative to percutaneous transhepatic biliary drainage and endoscopic retrograde cholangiography in the therapy of malignant pancreaticobiliary strictures, especially in patients who have undergone gastrectomy or partial gastrectomy with Billroth II reconstruction.
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              EUS-guided biliary drainage with transluminal stenting after failed ERCP: predictors of adverse events and long-term results.

              Do Hyun Park, Ji Woong Jang, Sang Lee … (2011)
              EUS-guided biliary drainage (EUS-BD) has been proposed as an effective alternative for percutaneous transhepatic biliary drainage (PTBD) after failed ERCP. To date, the risk factors for adverse events and long-term outcomes of EUS-BD with transluminal stenting (EUS-BDS) have not been fully explored. To evaluate risk factors for adverse events and long-term outcomes of EUS-BDS. Prospective follow-up study. Tertiary-care academic center. This study involved 57 consecutive patients with malignant or benign biliary obstruction undergoing EUS-BDS after failed ERCP. EUS-guided hepaticogastrostomy (EUS-HGS) and EUS-guided choledochoduodenostomy with transluminal stenting (EUS-CDS). Risk factors for postprocedure and late adverse events and clinical outcomes of EUS-BDS. The overall technical and functional success rates, respectively, in the EUS-BDS group were 96.5% (intention-to-treat, n = 55/57) and 89% (per-protocol, n = 49/55). Postprocedure adverse events developed after EUS-BDS in 11 patients (20%, n = 11/55). This included bile peritonitis (n = 2), mild bleeding (n = 2), and self-limited pneumoperitoneum (n = 7). In multivariate analysis, needle-knife use was the single risk factor for postprocedure adverse events after EUS-BDS (odds ratio 12.4; P = .01). A late adverse event in EUS-BDS was distal stent migration (7%, n = 4/55). The mean stent patencies with EUS-HGS and EUS-CDS were 132 days and 152 days, respectively. Single-operator performed, nonrandomized study. EUS-HGS and EUS-CDS may be relatively safe and can be used as an alternative to PTBD after failed ERCP. Both techniques offer durable and comparable stent patency. The use of a needle-knife for fistula dilation in EUS-BDS should be avoided if possible. Copyright © 2011 American Society for Gastrointestinal Endoscopy. Published by Mosby, Inc. All rights reserved.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Clin Endosc
                Journal ID (iso-abbrev): Clin Endosc
                Journal ID (publisher-id): CE
                Title: Clinical Endoscopy
                Publisher: Korean Society of Gastrointestinal Endoscopy
                ISSN (Print): 2234-2400
                ISSN (Electronic): 2234-2443
                Publication date (Print): May 2021
                Publication date (Electronic): 28 May 2021
                Volume: 54
                Issue: 3
                Pages: 301-308
                Affiliations
                [1 ]Department of Internal Medicine, Rajavithi Hospital, Bangkok, Thailand
                [2 ]Department of Surgery, Rajavithi Hospital, Bangkok, Thailand
                [3 ]Division of Gastroenterology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
                Author notes
                Correspondence: Nonthalee Pausawasdi Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand Tel: +66-2-419-7281, Fax: +66-22-411-5013, E-mail: nonthaleep7@ 123456gmail.com

                It is the invited review article.

                Author information
                http://orcid.org/0000-0001-5781-8696
                http://orcid.org/0000-0002-8579-1547
                http://orcid.org/0000-0002-3737-8555
                Article
                Publisher ID: ce-2021-103
                DOI: 10.5946/ce.2021.103
                PMC ID: 8182256
                PubMed ID: 34082486
                SO-VID: 7732578a-0e3d-4e87-bed1-fc822a6a9182
                Copyright © Copyright © 2021 Korean Society of Gastrointestinal Endoscopy
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 20 March 2021
                Date revision received : 25 April 2021
                Date accepted : 25 April 2021
                Categories
                Subject: Focused Review Series: Recent Updates on the Role of EUS in Pancreatobiliary Disease

                ScienceOpen disciplines: Radiology & Imaging
                Keywords: bile duct obstruction,biliary fistula,drainage,endoscopic ultrasonography
                Data availability:
                ScienceOpen disciplines: Radiology & Imaging
                Keywords: bile duct obstruction, biliary fistula, drainage, endoscopic ultrasonography

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