Apr 22, 2016

Technical tips for endoscopic ultrasound-guided hepaticogastrostomy

World Journal of Gastroenterology : WJG
Takeshi Ogura, Kazuhide Higuchi

Abstract

Interventional procedures using endoscopic ultrasound (EUS) have recently been developed. For biliary drainage, EUS-guided trans-luminal drainage has been reported. In this procedure, the transduodenal approach for extrahepatic bile ducts is called EUS-guided choledochoduodenostomy, and the transgastric approach for intrahepatic bile ducts is called EUS-guided hepaticogastrostomy (EUS-HGS). These procedures have several effects, such as internal drainage and avoiding post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis, and they are indicated for an inaccessible ampulla of Vater due to duodenal obstruction or surgical anatomy. EUS-HGS has particularly wide indications and clinical impact as an alternative biliary drainage method. In this procedure, it is necessary to dilate the fistula, and several devices and approaches have been reported. Stent selection is also important. In previous reports, the overall technical success rate was 82% (221/270), the clinical success rate was 97% (218/225), and the overall adverse event rate for EUS-HGS was 23% (62/270). Adverse events of EUS-biliary drainage are still high compared with ERCP or PTCD. EUS-HGS should continue to be performed by experienced endoscopists who c...Continue Reading

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Mentioned in this Paper

Ampulla of Semicircular Duct
Intrahepatic
Choledochoduodenostomy
Drainage of Right Internal Iliac Artery With Drainage Device, Percutaneous Approach
Pancreatitis
Benign Neoplasm of Extrahepatic Bile Ducts
Stent, Device
Duodenum
Ampulla of Vater
Retrograde Degeneration

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