Endoscopy 2021; 53(05): E196-E197
DOI: 10.1055/a-1226-6301
E-Videos

Endoscopic ultrasound-guided hepaticogastrostomy combined with gastroenterostomy in a case of complete duodenal obstruction

Shupeng Wang
Department of Gastroenterology, Shengjing Hospital of China Medical University, Shenyang, China
,
Jintao Guo
Department of Gastroenterology, Shengjing Hospital of China Medical University, Shenyang, China
,
Nan Ge
Department of Gastroenterology, Shengjing Hospital of China Medical University, Shenyang, China
,
Sheng Wang
Department of Gastroenterology, Shengjing Hospital of China Medical University, Shenyang, China
,
Wen Liu
Department of Gastroenterology, Shengjing Hospital of China Medical University, Shenyang, China
,
Siyu Sun
Department of Gastroenterology, Shengjing Hospital of China Medical University, Shenyang, China
› Author Affiliations
 

We report a successful case of hepaticogastrostomy combined with gastroenterostomy guided by endoscopic ultrasound (EUS) in a patient with unresectable carcinoma of the pancreatic head.

A 70-year-old woman presented with jaundice and vomiting for 3 weeks because of carcinoma of the pancreatic head. Attempts to implant a conventional intraluminal stent had failed three times owing to duodenal complete obstruction (twice at the previous hospital and once at our hospital). Therefore, we attempted EUS-guided hepaticogastrostomy and gastroenterostomy.

Because of poor function of the liver and disordered coagulation, we firstly performed hepaticogastrostomy as follows: (1) the intrahepatic bile duct (B3) was punctured with a 19-gauge needle; (2) a 0.035-inch guidewire was inserted; (3) the path was dilated with a 6-Fr cystotome; (4) a fully covered metal stent was implanted ([Video 1], part 1); and (5) a gastric tube was placed for external bile drainage. After 5 days, we performed a gastroenterostomy as follows: (1) following puncture, a 0.035-inch guidewire was inserted into jejunum; (2) enough saline was injected to display the proximal jejunum; and (3) a double-flanged fully covered metal stent with a cautery tip was implanted ([Video 1], part 2).

Video 1 Endoscopic ultrasound-guided hepaticogastrostomy combined with gastroenterostomy for complete duodenal obstruction.


Quality:

The stents functioned well until the patient developed vomiting in the third month after the operation. A computed tomography (CT) scan showed that the flange of the stent in the stomach had migrated. We implanted a new stent successfully, but the patient died owing to cerebral infarction a few days later.

To the best of our knowledge, this is the first report of hepaticogastrostomy combined with gastroenterostomy in a case of complete duodenal obstruction. Compared with previous reports [1] [2], the completely obstructed duodenum in the present case significantly increased the difficulty of the gastroenterostomy procedure, as it prevented the use of a balloon catheter or ultrafine gastroscope. Hepaticogastrostomy combined with gastroenterostomy produced a satisfactory effect, but the migration of the fully covered stent should be noted and any necessary intervention should be performed promptly [3] [4] [5].

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Competing interests

The authors declare that they have no conflict of interest.


Corresponding author

Siyu Sun, MD
Department of Gastroenterology
Shengjing Hospital of China Medical University
No. 36, Sanhao Street, Shenyang
Liaoning Province, 110004
China   
Fax: +86-24-23892617   

Publication History

Publication Date:
02 September 2020 (online)

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