Abstract
Hepaticogastrostomy (HGS) serves as an alternative approach for biliary drainage in
patients with difficult-to-cross perihilar biliary strictures. Although endoscopic
ultrasound-guided HGS (EUS-HGS) has become widely accepted, it can sometimes fail
due to technical challenges with duct access and guidewire manipulation. In such situations,
percutaneous HGS (P-HGS) offers a valuable alternative. We report our experience with
three patients treated with P-HGS between February 2020 and July 2023. Conventional
percutaneous and endoscopic methods as well as EUS-HGS had failed to internalize the
drainage catheter in all the cases. Technical success was achieved in all the three
cases. Self-limiting bile leak was seen in one patient. Rest of the patients did not
develop any major complications. After a mean follow-up of 10.3 months (range, 5–14
months), P-HGS stents were patent in all three patients. In conclusion, P-HGS is technically
feasible and an effective alternative to EUS-HGS or long-term external biliary drainage
for noninternalizable malignant biliary strictures.
Keywords
hepaticogastrostomy - endoscopic ultrasound - cholangiocarcinoma
