Endoscopy 2025; 57(S 02): S567
DOI: 10.1055/s-0045-1806482
Abstracts | ESGE Days 2025
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Double EUS-Guided Hepaticogastrostomy as Palliative Treatment for Biliary Obstruction Due to a Klatskin Tumor

Authors

  • E Allemant Castañeda

    1   Navarra Hospital Complex – Navarra Hospital, Pamplona, Spain

  • A Arrubla

    1   Navarra Hospital Complex – Navarra Hospital, Pamplona, Spain

  • C Bitrian Sistac

    1   Navarra Hospital Complex – Navarra Hospital, Pamplona, Spain

  • S Pinto Martinez

    1   Navarra Hospital Complex – Navarra Hospital, Pamplona, Spain

  • D Fall

    1   Navarra Hospital Complex – Navarra Hospital, Pamplona, Spain

  • N Hervás

    1   Navarra Hospital Complex – Navarra Hospital, Pamplona, Spain

  • R Irisarri

    1   Navarra Hospital Complex – Navarra Hospital, Pamplona, Spain

  • J Carrascosa Gil

    1   Navarra Hospital Complex – Navarra Hospital, Pamplona, Spain

  • I Fernández-Urién

    1   Navarra Hospital Complex – Navarra Hospital, Pamplona, Spain

  • J J Vila

    1   Navarra Hospital Complex – Navarra Hospital, Pamplona, Spain
Further Information
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Endoscopic drainage of hilar cholangiocarcinoma is technically challenging, and its optimal strategy remains unclear.

An 83-year-old male with a history of Billroth II gastrectomy and hilar cholangiocarcinoma under palliative care initially treated with transpapillary drainage of the right bile duct. Subsequently, he developed recurrent episodes of cholangitis due to tumoral growth within the stent. In a following episode of cholangitis, an ERCP revealed complete obstruction of the left bile duct caused by tumor progression. A hepaticogastrostomy of segment II was performed, demonstrating stenosis at the root of segments II and III, although contrast passage into segment III was observed. Attempts to pass various guidewires into segment III for drainage were unsuccessful.

The patient developed acute cholangitis again. Endoscopy confirmed appropriate drainage of segment II via the hepaticogastrostomy, without communication with segment III. EUS-guided puncture of segment III was performed anterior to the prior hepaticogastrostomy, followed by the placement of an 8-cm covered metallic stent, allowing pus drainage and completion of a second hepaticogastrostomy

Double hepaticogastrostomy is uncommon due to the difficulty in identifying an appropriate window after an initial hepaticogastrostomy, which is usually sufficient. In our case, both drainages were necessary due to tumor-induced isolation of the left segments. The segment II hepaticogastrostomy was insufficient as it did not allow effective drainage of segment III, where purulent cholangitis developed, necessitating the second hepaticogastrostomy [1].



Publication History

Article published online:
27 March 2025

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