Endoscopic ultrasound guided biliary interventions

Rescue technique after endoscopic ultrasound-guided hepaticogastrostomy stent dislocation

“…Endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) has been indicated after failed endoscopic retrograde cholangiopancreatography (ERCP). Critical adverse events such as stent migration or dislocation can occur during EUS-HGS 1 2 3 . If a fistula is not formed after the occurrence of these adverse events, an alternative biliary drainage technique is required, such as percutaneous transhepatic biliary drainage and endoscopic suture of the anastomotic defect left behind after the EUS-HGS stent.…”

Role of endoscopy in hepatology

“…Nowadays ERCP and EUS are undeniably intertwined as part of the integrated approach to biliopancreatic disorders, both diagnostically and therapeutically, and are therefore often referred to as EUSRCP [8 , 9 , 11 , 16] . Meanwhile, a myriad of internal biliary drainage techniques facilitated by EUS-assisted biliary access have expanded our options, in addition to percutaneous approaches, with similar or even improved efficacy, safety and tolerance, which are extensively discussed elsewhere [16] . For hepatologists, biliary interventions in patients with cirrhosis and for post-transplant biliary complications as well as diagnostic and endo-therapeutic challenges in primary sclerosing cholangitis (PSC) form the most substantial interface between hepatology and endoscopy [ 8-10 , 17-19] .…”

Troubleshooting for difficult removal of a stent delivery system after endoscopic ultrasound-guided hepaticogastrostomy

“…Endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) is now widely performed for patients in whom endoscopic retrograde cholangiopancreatography is unsuccessful 1 2 3 4 . Various technical tips have been reported for preventing adverse events and improving the technical success rate before stent deployment.…”