Endoscopy 2017; 49(06): 544-548
DOI: 10.1055/s-0043-102388
Innovations and brief communications
© Georg Thieme Verlag KG Stuttgart · New York

Conversion of external percutaneous transhepatic biliary drainage to endoscopic ultrasound-guided hepaticogastrostomy after failed standard internal stenting for malignant biliary obstruction

Woo Hyun Paik1, Nah Kyum Lee2, Yousuke Nakai3, Hiroyuki Isayama3, Dongwook Oh2, Tae Jun Song2, Sang Soo Lee2, Dong-Wan Seo2, Sung Koo Lee2, Myung-Hwan Kim2, Do Hyun Park2
  • 1Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang, and Seoul National University College of Medicine, Seoul, Korea
  • 2Division of Gastroenterology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
  • 3Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
Further Information

Publication History

submitted 17 October 2016

accepted after revision: 16 January 2017

Publication Date:
14 February 2017 (eFirst)


Background and study aim Percutaneous transhepatic biliary drainage (PTBD) is a rescue procedure after a failed endoscopic retrograde cholangiopancreatography. As PTBD causes patient discomfort, conversion of the PTBD to internal biliary stenting (PTBDS) may be required; however, PTBDS is sometimes difficult because of the tight stricture. We evaluated the efficacy and safety of conversion of external PTBD to endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) after failed PTBDS.

Patients and methods A total of 16 patients with malignant distal biliary obstruction who underwent conversion of external PTBD to EUS-HGS after failed PTBDS were enrolled from two institutions in Korea and Japan. Data were analyzed retrospectively.

Results The technical and clinical success rates were 100 % and 81 %, respectively. Early adverse events developed in two patients: proximal stent migration (n = 1), and cholecystitis (n = 1). Stents were occluded or migrated distally in five patients. The mean duration of stent patency was 402 days.

Conclusions Conversion of external PTBD to EUS-HGS may be a good rescue option after failed PTBDS.