What You Need to Know Before Performing Endoscopic Ultrasound-guided Hepaticogastrostomy
- Author:
Tanyaporn CHANTAROJANASIRI
1
;
Thawee RATANACHU-EK
;
Nonthalee PAUSAWASDI
Author Information
- Publication Type:Focused Review Series: Recent Updates on the Role of EUS in Pancreatobiliary Disease
- From:Clinical Endoscopy 2021;54(3):301-308
- CountryRepublic of Korea
- Language:English
- Abstract: Endoscopic retrograde cholangiopancreatography (ERCP) is the primary treatment modality for bile duct obstruction. When ERCP is unsuccessful, percutaneous transhepatic biliary drainage can be an alternative method. Endoscopic ultrasound-guided biliary drainage (EUS-BD) has emerged as a treatment option for biliary obstruction, especially after ERCP failure. EUS-BD offers transluminal intrahepatic and extrahepatic drainage through a transgastric and transduodenal approach. EUS-guided hepaticogastrostomy (EUS-HGS) is an excellent choice for patients with hilar strictures or those with a surgically altered anatomy. The optimal steps in EUS-HGS are case selection, bile duct visualization, puncture-site selection, wire insertion and manipulation, tract dilation, and stent placement. Caution should be taken at each step to prevent complications. Dedicated devices for EUS-HGS have been developed to improve the technical success rate and reduce complications. This technical review focuses on the essential practical points at each step of EUS-HGS.
