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

• Published in: Clinical endoscopy Vol. 54; no. 3; pp. 301 - 308
• Main Authors: Tanyaporn Chantarojanasiri, Thawee Ratanachu-ek, Nonthalee Pausawasdi
• Format: Journal Article
• Language: Korean
• Published: 대한소화기내시경학회 30.05.2021
• Subjects: Bile duct obstruction; Biliary fistula; Drainage; Endoscopic ultrasonography
• ISSN: 2234-2400

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. Clin Endosc 2021;54:301-308