Successful endoscopic treatment of iatrogenic biloma as a complication of endosonography-guided hepaticogastrostomy: The first case report

Abstract

Endosonography (EUS)-guided biliary drainage is a novel therapeutic option for patients with biliary obstruction after failed endoscopic retrograde cholangiopancreatography (ERCP). Many case reports and series worldwide have shown satisfactory clinical outcomes in terms of technical and clinical success rates, which approach 80%-100%. However, these procedures need to be performed by experts to minimize the possible complications, which have been reported in as many as 14-35% of patients. The most common complications encountered in these procedures are bile leakage, pneumoperitoneum, peritonitis, and stent related complications such as stent migration. Here, we report the case of a female patient who had cholangiocarcinoma and underwent EUS-guided hepaticogastrostomy after failed ERCP; stent malposition occurred during the procedure, leading to biloma formation that was successfully treated with EUS-guided biloma drainage.

Effect of echoendoscope angle on success of guidewire manipulation during endoscopic ultrasound-guided hepaticogastrostomy

“…Our results might also have another advantage. Indications for EUS-BD have expanded not only for malignant tumors, but also for benign biliary diseases [19][20][21]. Compared with malignant biliary obstruction, the intrahepatic bile duct is less dilated in benign disease.…”

“…Among EUS-BD procedures, various interventional techniques via an EUS-guided hepaticogastrostomy (HGS) route have been described [15][16][17][18]. However, EUS-HGS shows disadvantages such as a risk of stent migration into the abdominal cavity or bile leakage if EUS-HGS fails [19,20]. Successful EUS-HGS is thus extremely important to prevent adverse events.…”

EUS-guided antegrade procedures

“…[17] Other adverse events such as liver abscess, biloma, and focal cholangitis are also concerned by blocking the branch of bile duct. [394041] Previously, Umeda et al . [42] reported the technical feasibility and safety of a newly designed 8F plastic stent dedicated for EUS-HES.…”

Endoscopic ultrasound.guided fine-needle tissue acquisition – A review and update of literature

“…The incidence of biliary peritonitis as an adverse event from a diagnostic FNA is low, though higher when EUS guided biliary drainage is used as a salvage therapy when ERCP fails. [104][105][106] There have been few anecdotal reports of malignant seeding of the needle track, that were lower than those associated with percutaneous sampling. [107][108][109] More recent studies have shown that preoperative EUS-FNA of pancreatic neoplasms was not associated with an increased risk of seeding or decreased overall survival.…”