EUS-guided hepaticogastrostomy for management of cholangitis, hepatolithiasis, and anastomotic stricture after Roux-en-Y hepaticojejunostomy

Pawa, Rishi; Jiang, Diana; Gilliam, John H.; Clark, Clancy J.; Pawa, Swati

doi:10.1016/j.vgie.2021.01.013

Cited by 4 publications

(2 citation statements)

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“…27,28 Recently, the usefulness of EUS-guided biliary drainage (EUS-BD) for HJAS has been reported. 29,30 Despite a high success rate, EUS-BD procedures have problems with a high rate of AEs. 31 Many problems remain unresolved, including longterm outcomes, procedural standardization, and development of specialized devices.…”

Section: Discussionmentioning

confidence: 99%

Risk factors for recurrent stenosis after balloon dilation for benign hepaticojejunostomy anastomotic stricture

et al. 2024

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Background/Aims: Hepaticojejunostomy anastomotic stricture (HJAS) is a feared adverse event associated with hepatopancreatobiliary surgery. Although balloon dilation for benign HJAS during endoscopic retrograde cholangiopancreatography with balloon-assisted enteroscopy has been reported to be useful, the treatment strategy remains controversial. Therefore, we evaluated the outcomes and risk factors of recurrent stenosis after balloon dilation alone for benign HJAS.Methods: We retrospectively analyzed consecutive patients who underwent balloon-assisted enteroscopy–endoscopic retrograde cholangiopancreatography for benign HJAS at our institution between July 2014 and December 2020.Results: Forty-six patients were included, 16 of whom had recurrent HJAS after balloon dilation. The patency rates at 1 and 2 years after balloon dilation were 76.8% and 64.2%, respectively. Presence of a residual balloon notch during balloon dilation was an independent predictor of recurrence (hazard ratio, 2.80; 95% confidence interval, 1.01–7.78; p=0.048), whereas HJAS within postoperative 1 year tended to be associated with recurrence (hazard ratio, 2.43; 95% confidence interval, 0.85–6.89; p=0.096). The patency rates in patients without a residual balloon notch were 82.1% and 73.1% after 1 and 2 years, respectively.Conclusions: Balloon dilation alone may be a viable option for patients with benign HJAS without residual balloon notches on fluoroscopy.

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Section: Discussionmentioning

confidence: 99%

Risk factors for recurrent stenosis after balloon dilation for benign hepaticojejunostomy anastomotic stricture

et al. 2024

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“…EUS-HGS is a potential salvage treatment for hepatolithiasis in patients with SAA [ 15 , 29 ], and there are some case reports for successful removal of hepatolithiasis using HGS route [ 30 ]. Furthermore, direct cholangioscopy through the HGS route and subsequent electrohydraulic lithotripsy under a direct visualization could be an option for large stones [ 31 ]. However, data on the safety and effectiveness of EUS-HGS for hepatolithiasis are still limited to date, and furthermore, removal of hepatolithiasis in the right lobe is challenging through HGS route [ 32 ].…”

Section: Discussionmentioning

confidence: 99%

Balloon endoscopy-assisted endoscopic retrograde cholangiopancreatography for hepatolithiasis in patients with hepaticojejunostomy

Hakuta,

Sato,

Nakai

et al. 2024

Surg Endosc

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Background and aim Balloon endoscopy-assisted endoscopic retrograde cholangiopancreatography (BE-ERCP) is an emerging procedure for pancreatobiliary diseases in patients with surgically altered anatomy. However, data on BE-ERCP for hepatolithiasis after hepaticojejunostomy (HJS) are still limited. Methods Stone removal success, adverse events and recurrence were retrospectively studied in consecutive patients who underwent BE-ERCP for hepatolithiasis after HJS between January 2011 and October 2022. Subgroup analysis was performed to compare clinical outcomes between patients who had undergone HJS over 10 years before (past HJS group) and within 10 years (recent HJS group). Results A total of 131 patients were included; 39% had undergone HJS for malignancy and 32% for congenital biliary dilation. Scope insertion and complete stone removal were successful in 89% and 73%, respectively. Early adverse events were observed in 9.9%. Four patients (3.1%) developed gastrointestinal perforation but could be managed conservatively. Hepatolithiasis recurrence rate was 17%, 20% and 31% in 1-year, 3-year, and 5-year after complete stone removal. The past HJS group was the only risk factor for failed stone removal (odds ratio 10.4, 95% confidence interval 2.99–36.5) in the multivariable analysis. Failed scope insertion (20%) and failed guidewire or device insertion to the bile duct (22%) were two major reasons for failed stone removal in the past HJS group. Conclusions BE-ERCP for hepatolithiasis was effective and safe in cases with HJS but the complete stone removal rate was low in the past HJS group. Recurrent hepatolithiasis was common and careful follow up study is needed even after complete stone removal.

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EUS-guided hepaticogastrostomy (EUS-HGS) for transhepatic removal of hepatolithiasis in Caroli's disease (CD)

Martinez-Ortega,

Sánchez-Ocaña,

Latras-Cortés

et al. 2023

ESGE Days 2023

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EUS-guided hepaticogastrostomy for management of cholangitis, hepatolithiasis, and anastomotic stricture after Roux-en-Y hepaticojejunostomy

Abstract: Video Video 1 EUS-guided hepaticogastrostomy for management of cholangitis, hepatolithiasis, and anastomotic stricture after Roux-en-Y hepaticojejunostomy.

Cited by 4 publications

References 0 publications

Risk factors for recurrent stenosis after balloon dilation for benign hepaticojejunostomy anastomotic stricture

Risk factors for recurrent stenosis after balloon dilation for benign hepaticojejunostomy anastomotic stricture

Balloon endoscopy-assisted endoscopic retrograde cholangiopancreatography for hepatolithiasis in patients with hepaticojejunostomy

EUS-guided hepaticogastrostomy (EUS-HGS) for transhepatic removal of hepatolithiasis in Caroli's disease (CD)

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