Practical Tips for Safe and Successful Endoscopic Ultrasound-Guided Hepaticogastrostomy: A State-of-the-Art Technical Review

Abstract

Currently, endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) is widely performed worldwide for various benign and malignant biliary diseases in cases of difficult or unsuccessful endoscopic transpapillary cholangiopancreatography (ERCP). Furthermore, its applicability as primary drainage has also been reported. Although recent advances in EUS systems and equipment have made EUS-HGS easier and safer, the risk of serious adverse events such as bile leak and stent migration still exists. Physicians and assistants need not only sufficient skills and experience in ERCP-related procedures and basic EUS-related procedures such as fine needle aspiration and pancreatic fluid collection drainage, but also knowledge and techniques specific to EUS-HGS. This technical review mainly focuses on EUS-HGS with self-expandable metal stents for unresectable malignant biliary obstruction and presents the latest and detailed tips for safe and successful performance of the technique.

Combined Bile Duct Ablation and Fistulous Tract Embolization Using N-Butyl Cyanoacrylate to Manage a Biliary-Cutaneous Fistula Following Percutaneous Transhepatic Biliary Drainage (PTBD) for Hilar Cholangiocarcinoma

“…Therefore, endoscopic hepaticogastrostomy may not always be possible. 12 In our case, bile duct ablation by glue was performed first due to the inability to cannulate the fistula. Persistent low output demanded a second treatment when the fistulous tract was embolized.…”

Removal of a small pancreatic stone in thin main pancreatic duct using an ultrafine balloon catheter (with video)

“…Pancreatography showed that the main pancreatic duct was so thin that although a 0.025‐inch guidewire (EndoSelecor; Boston Scientific Japan) could be advanced beyond the stone, a standard ERCP catheter (01 20 21 1; MTW Endoskopie) could not pass the stone. Considering that any basket catheter or retrieval balloon catheter would not be able to pass the stone, an ultrafine catheter with a 3‐Fr tip and 4‐mm dilation balloon (REN; Kaneka Medix) 1,2 (Figure 2) was applied. The REN was advanced carefully so as not to push the stone in and was successfully inserted beyond the stone.…”

Clinical Advances in the Diagnosis and Treatment of Biliary Tract Diseases

“…Among EUS-BD procedures, EUS-guided hepaticogastrostomy (EUS-HGS) has traditionally been performed only in high-volume centers because of its high technical difficulty and the possibility of serious complications such as biliary peritonitis and stent migration, but recent advances in devices and the accumulation of knowledge on techniques [ 1 , 2 ] have made it possible for trained endoscopists to perform EUS-HGS safely and successfully in general hospitals [ 3 ]. In the future, not only will the further development of dedicated devices but also education using phantom models will be important for generalization.…”