Subscribe to RSS
Download PDF
DOI: 10.1055/a-2641-1807
Endoscopic ultrasound-guided drainage of a right liver fistula caused by percutaneous thermoablation
We present a case of a 35-year-old man who developed a biloma in the right liver following thermoablation for liver metastasis. His medical history included distal splenopancreatectomy for grade 2 neuroendocrine tumors, followed by left hepatectomy for liver metastasis 5 years before. The patient recently underwent chemotherapy and a few sessions of percutaneous thermoablation for liver metastases. The biloma was treated via percutaneous drainage ([Fig. 1]). However, after noting that the biloma was only partially resolved, a biliary fistula was identified. Endoscopic retrograde cholangiopancreatography was attempted, but the bile ducts were atrophied; thus, cannulation of the target bile duct failed. Neither sphincterotomy nor plastic stent placement in the right liver resolved the fistula. After multidisciplinary discussions, we opted to internalize the biliary fistula via endoscopic ultrasound (EUS)-guided drainage. This approach was selected based on research indicating that the right liver is accessible via EUS [1] [2] [3]. A curved linear therapeutic EUS-scope was introduced into the duodenum under fluoroscopy. Contrast and saline solution were injected into the fistula through a percutaneous drain to delineate the trajectory under EUS and fluoroscopy ([Fig. 2]). The fistula was punctured from the duodenum using a 19-G needle, and a 0.025-in guidewire was inserted. The tract was first dilated using a 6-Fr cystotome and then a 4-mm biliary balloon catheter. A double pigtail stent was inserted into the fistula and duodenum. Minor bleeding occurred but ceased spontaneously. Contrast was injected via the percutaneous drain, and successful drainage of the contrast agent into the duodenum confirmed correct placement of the stent ([Fig. 3]). One week later, a second double pigtail stent was placed parallel to the first ([Video 1]). The percutaneous drain was removed 48 hours later. This video shows a valid EUS-guided alternative for internalizing a biliary fistula from the duodenum when standard methods fail.
Endoscopy_UCTN_Code_TTT_1AS_2AH
E-Videos is an open access online section of the journal Endoscopy, reporting on interesting cases and new techniques in gastroenterological endoscopy.
All papers include a high-quality video and are published with a Creative Commons
CC-BY license. Endoscopy E-Videos qualify for HINARI discounts and waivers and eligibility is automatically checked during the submission
process. We grant 100% waivers to articles whose corresponding authors are based in
Group A countries and 50% waivers to those who are based in Group B countries as classified
by Research4Life (see: https://www.research4life.org/access/eligibility/).
This section has its own submission website at https://mc.manuscriptcentral.com/e-videos.
Publication History
Article published online:
25 July 2025
© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).
Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany
-
References
- 1 Nakai Y, Matsubara S, Mukai T. et al. Drainage for fluid collections post pancreatic surgery and acute pancreatitis: similar but different?. Clin Endosc 2024; 57: 735-746
- 2 Caillol F, Rouy M, Pesenti C. et al. Drainage of the right liver using EUS guidance. Endosc Ultrasound 2019; 8 (Suppl. 01) S50-S56
- 3 Shah J, Jena A, Singh AK. et al. Endoscopic Ultrasound (EUS)-guided Drainage of Caudate Lobe Abscess: A Single Center Experience. Surg Laparosc Endosc Percutan Tech 2023; 33: 682-687