Year 2024 / Volume 116 / Number 12
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EUS-guided hepaticogastrostomy in multimetastatic liver disease – an effective approach for biliary drainage that may complement ERCP

690-692

DOI: 10.17235/reed.2023.9605/2023

Gonçalo Nunes, Pedro Pinto-Marques, Francisco Vara-Luiz, Jorge Fonseca,

Abstract
A 36-year-old male was diagnosed with a metastasized colon adenocarcinoma causing obstructive jaundice. Magnetic resonance cholangiography showed a dominant lesion causing hilar stenosis. The patient was submitted to endoscopic retrograde cholangiopancreatography (ERCP), nevertheless it was just possible to place a single uncovered self-expandable metallic stent (SEMS) in the right lobe. Although cholestasis significantly improved, safe levels for oncologic therapy were not reached. EUS-guided hepaticogastrostomy was proposed to complement ERCP biliary drainage. Using a forward-viewing echoendoscope and a transgastric approach, EUS-guided puncture of a dilated left intrahepatic duct at segment III was accomplished with a 19G needle (EchoTip ProCore®) that allowed passage of a 0.035 guidewire. A 6F cystotome and biliary dilators (5Fr+8.5Fr) were used for needle tract dilation. A partially-covered SEMS (GIOBOR™ 8x100mm) could be deployed under endoscopic and fluoroscopic control, being placed 3cm inside the gastric lumen. No associated complications were observed after the procedure.
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References
1. Giovannini M. EUS-guided hepaticogastrostomy. Endosc Ultrasound. 2019; 8(Suppl 1): S35-S39.
2. Pinto-Carta R, Sierra-Arango F, Espriella DS, Vásquez-Roldán M. A single session of EUS directed transgastric ERCP and EUS FNB in a patient with RYGB, pancreatic head tumor and biliary obstruction. Rev Esp Enferm Dig 2022 Sep;114(9):559-560. doi: 10.17235/reed.2022.8743/2022.
3. van der Merwe SW, van Wanrooij RLJ, Bronswijk M, Everett S, Lakhtakia S, Rimbas M, Hucl T, Kunda R, Badaoui A, Law R, Arcidiacono PG, Larghi A, Giovannini M, Khashab MA, Binmoeller KF, Barthet M, Perez-Miranda M, van Hooft JE. Therapeutic endoscopic ultrasound: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy. 2022; 54(2):185-205.
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Nunes G, Pinto-Marques P, Vara-Luiz F, Fonseca J. EUS-guided hepaticogastrostomy in multimetastatic liver disease – an effective approach for biliary drainage that may complement ERCP. 9605/2023


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Publication history

Received: 19/03/2023

Accepted: 28/03/2023

Online First: 19/04/2023

Published: 13/12/2024

Article Online First time: 31 days

Article editing time: 635 days


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