The role of EUS-hepaticogastrostomy in benign diseases: a case-series

Aims Current guidelines recommend endoscopic ultrasound guided hepaticogastrostomy (EUS-HGS) as a choice in malignant biliary obstruction [1]. We present a series of 3 patients who underwent HGS for benign disease

Methods A retrospective search in our databases was conducted until October 2022. The primary endpoint was to assess the technical success of EUS-HGS, followed by clinical success (the ability to provide complete treatment), and adverse events related to the procedure.

Results Three cases were reviewed. A 60 years old man, with non-traversable duodenal stricture, biliary stones and failed attempts for ERCP. EUS-HGS was performed successfully with a fully covered self-expanding metal stent (fcSEMS), without complications, providing access for trans-HGS cholangioscopy with lithotripsy after tract maturation. The second patient was a 39 years old female with a background of a hepaticojejunostomy, due to biliary reconstruction in infancy, and complex left hepatic duct stone disease. EUS-HGS was successful with a fcSEMS, though complicated with cholangitis and slight stent migration towards the liver. Trans-HGS cholangioscopy with lithotripsy achieved complete duct clearance. Finally, a 38 years old woman, with a history of Roux-en-Y anastomosis, presented with afferent loop syndrome and secondary biliary obstruction. EUS-HGS with a dedicated stent decompressed biliary tree to the efferent loop without adverse events [1].

Conclusions EUS-HGS could be an alternative in selected cases with benign biliary diseases. Further studies with prolonged follow up are required to assess its feasibility and any future impact on patients with long life expectancy.

 

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Conflicts of interest

Authors do not have any conflict of interest to disclose.

• 1 van der Merwe SW, van Wanrooij RLJ, Bronswijk M. et al. Therapeutic endoscopic ultrasound: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy 2022; 54: 185-205

Publication History

Article published online:
14 April 2023