Endoscopic ultrasound (EUS)-guided transgastric after distal gastrectomy left-intrahepatic- bile drainage: a case report

Background: This case report describes a novel application of EUS-guided transgastric left-intrahepatic- bile drainage after distal gastrectomy which a trans-left-hepatic approach was used to alleviate distal biliary obstructions when this could not be accomplished at ERCP.

Methods: EUS-guided transgastric left-intrahepatic- bile drainage was used to alleviate symptoms of biliary obstruction in a 56-year-old Chinese woman with hilar cholangiocarcinoma. In this case, after transgastric puncture of an intra-left-hepatic branch of the obstructed bile duct with a 19-gauge EUS needle, a guidewire was advanced antegrade in the enlarged left-hepatic-biliary. Subsequently, an 8.5F plastic stent with 7-cm length was placed under echo endoscopic and fluoroscopic view. The wall of stomach was closed by 2 long arm hemostats.

Observations: EUS-guided transgastric left-intrahepatic- bile drainage was performed. Stent placement was successful in this patient. There was no immediate complication of the procedures. After a week, the total bilirubin decreased by nearly 1/2.

Conclusions: EUS-guided transgastric left-intrahepatic- bile drainage with a plastic stent may be a feasible and relatively safe alternative to PTBD when ERCP is unsuccessful because of distal gastrectomy.