Apr 20, 2016

EUS hepaticogastrostomy for bilioenteric anastomotic strictures: a permanent access for repeated ambulatory dilations? Results from a pilot study

Endoscopy International Open
Pablo Miranda-GarcíaMarc Barthet

Abstract

Postsurgical benign bilioenteric anastomotic strictures are a major adverse event of biliary surgery and endoscopic treatment, including endoscopic retrograde cholangiopancreatography (ERCP), is challenging in this setting. We present an innovative approach to treating this complication. Patients underwent endoscopic ultrasound (EUS)-hepaticogastrostomy (HG) to treat nonmalignant biliary obstructions. A first endoscopy was performed to create the hepaticogastrostomy and to drain the biliary tree. The second step had a therapeutic purpose: antegrade dilation of the anastomosis. Four men and three women with benign bilioenteric anastomotic strictures were included. Patients presented with jaundice or recurrent cholangitis. A fully covered HG stent was successfully deployed during the first endoscopy. During the second step, repeat antegrade dilation was performed through the HG in four cases (1 - 4 dilations) followed by double pigtail stenting in three cases. In three other patients, the stenosis was not crossable and a double pigtail stent was placed to maintain biliary drainage. All patients had symptom relief at the end of follow-up (45 weeks, range 33 - 64). Dilation of anastomotic stenosis through a hepaticogastrostomy is f...Continue Reading

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Mentioned in this Paper

Endoscopy (Procedure)
Anastomosis, Surgical
Yellow Skin or Eyes (Symptom)
Anatomical Anastomosis
Follow-up
Biliary Tract Structure
Stent, Device
Retrograde Degeneration
Pilot Projects
Pathological Dilatation

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