EUS GUIDED HEPATICOGASTROSTOMY AND CHOLANGIOSCOPY FOR DIFFICULT INTRAHEPATIC BILE DUCT STONES

Biliary stones can be difficult to treat for many reasons, including surgically altered anatomy precluding conventional endoscopic access.

This 39y patient underwent hepaticojejunostomy as an infant and subsequently developed large calculi above the hepaticojejunostomy anastomosis causing cholangitis. The dilated intrahepatic ducts containing calculi were in the left liver and were not accessible percutaneously.

EUS hepticogastrostomy (HGS) insertion enabled subsequent stone therapy with cholangioscopy and EHL. Two sessions of intraductal therapy cleared the intrahepatic ducts and importantly biliary access via HGS has been maintained for any future therapy.

The video attached demonstrates the technique for HGS placement and subsequent stone therapy.

Publication History

Article published online:
14 April 2022