EUS-guided hepaticogastrostomy in the management of malignant biliary obstruction: Experience and learning curve in a tertiary referral center

Giovannini, Marc; Caillol, Fabrice; Sfumato, Patrick; Romero, Juan Luis Orradre; Ratone, Jean‐Philippe; Pesenti, Christian; Godat, Sébastien; Hoibian, Solène; Dahel, Yanis; Boher, Jean Marie

doi:10.1016/j.dld.2022.05.008

Cited by 8 publications

(4 citation statements)

References 14 publications

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“…10 Bile leakage into the abdominal cavity and stent migration are the most serious complications of this procedure. 15,[24][25][26] Ascites carries the potential risk of complications, such as infectious peritonitis, which are occasionally serious. We previously reported a case of severe infectious peritonitis after EUS-HGS in a patient with ascites.…”

Section: Discussionmentioning

confidence: 99%

Safety of endoscopic ultrasound-guided hepaticogastrostomy in patients with malignant biliary obstruction and ascites

Yasuda,

Hara,

Mizuno

et al. 2024

Clin Endosc

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Background/Aims: Endoscopic ultrasound (EUS)-guided hepaticogastrostomy (EUS-HGS) is useful for patients with biliary cannulation failure or inaccessible papillae. However, it can lead to serious complications such as bile peritonitis in patients with ascites; therefore, development of a safe method to perform EUS-HGS is important. Herein, we evaluated the safety of EUS-HGS with continuous ascitic fluid drainage in patients with ascites.Methods: Patients with moderate or severe ascites who underwent continuous ascites drainage, which was initiated before EUS-HGS and terminated after the procedure at our institution between April 2015 and December 2022, were included in the study. We evaluated the technical and clinical success rates, EUS-HGS-related complications, and feasibility of re-intervention.Results: Ten patients underwent continuous ascites drainage, which was initiated before EUS-HGS and terminated after completion of the procedure. Median duration of ascites drainage before and after EUS-HGS was 2 and 4 days, respectively. Technical success with EUS-HGS was achieved in all 10 patients (100%). Clinical success with EUS-HGS was achieved in 9 of the 10 patients (90 %). No endoscopic complications such as bile peritonitis were observed.Conclusions: In patients with ascites, continuous ascites drainage, which is initiated before EUS-HGS and terminated after completion of the procedure, may prevent complications and allow safe performance of EUS-HGS.

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Section: Discussionmentioning

confidence: 99%

Safety of endoscopic ultrasound-guided hepaticogastrostomy in patients with malignant biliary obstruction and ascites

Yasuda,

Hara,

Mizuno

et al. 2024

Clin Endosc

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“…La hepaticogastrostomía guiada por EUS (EUS-HGS) es una estrategia reconocida de segunda línea para el drenaje biliar cuando la colangiopancreatografía retrógrada endoscópica falla o es imposible la canulación a nivel duodenal, con un éxito clínico hasta de un 93% y un seguimiento a 30 días con morbilidad del 18%, cuya complicación más común es la oclusión recurrente del stent biliar, y una mortalidad del 5% (3) .…”

Section: Casounclassified

Endoscopic Ultrasound-guided Hepaticogastrostomy, Experience in Colombia: Case Series

Hernández Sampayo,

Sierra Arango,

Pinto Carta

2024

Rev. colomb. Gastroenterol.

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La principal herramienta para la obstrucción biliar maligna es la descompresión de la vía biliar, mediante la colangiopancreatografía retrógrada endoscópica (CPRE) con colocación de stent, la cual en un gran porcentaje de los casos es satisfactoria; sin embargo, el verdadero reto se presenta cuando es imposible canular la papila de váter por compromiso neoplásico a ese nivel. Aunque el drenaje biliar transhepático percutáneo (PTBD) es una opción, representa una gran morbilidad, que repercute directamente en la calidad de vida del paciente al tener un dispositivo externo sumado a una patología maligna. Con la llegada de la ultrasonografía endoscópica (USE), existen nuevos métodos reportados como la hepaticogastrostomía guiada por EUS (EUS-HGS), la cual se realiza por un orificio natural (NOTES) e impacta positivamente en el desenlace de estos pacientes. A continuación, se ejemplifica nuestra experiencia con los primeros 3 casos en Colombia.

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“…Since the first hepaticogastrostomy (HGS) in 2001 [2], the procedure has gradually replaced percutaneous drainage for malignant lesions due to its lower risk of morbidities reported in randomized studies [3]. The safety of EUS has also improved due to the increasing number of EUS-HGS procedures being performed [4]. EUS-guided biliary drainage (EUS-BD) has become a valuable option for gaining access to the bile duct in patients with benign disease of the bile duct and inaccessible papilla [5].…”

Section: Introductionmentioning

confidence: 99%

“…Since the first hepaticogastrostomy (HGS) in 2001 2 , the procedure has gradually replaced percutaneous drainage for malignant lesions due to the lower risk of morbidities reported in randomized studies 3 . The safety of endoscopic ultrasound (EUS) has also improved due to the increasing number of EUS-HGS procedures being performed 4 .…”

Section: Introductionmentioning

confidence: 99%

EUS-BD for calibration of benign stenosis of the bile duct in patients with altered anatomy or inaccessible papilla

Caillol,

Godat,

Solovyev

et al. 2024

Endosc Int Open

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Background and study aims In cases of inaccessible papilla, EUS-guided biliary drainage (EUS-BD) has been described as an alternative to calibrate benign biliary stenosis. However, few studies are available. Patients and methods This tw-center, retrospective study was designed to evaluate technical success and clinical success at 1 year. All patients who underswent EUS-BD without the rendezvous technique used for calibration of benign biliary stenosis were included from 2016 to 2022. Patients underwent EUS-hepaticogastrostomy (EUS-HGS) during the first session. Then, HGS was used to access the bile duct, allowing calibration of the stenosis: Dilation of the biliary stenosis and placement of double pigtail stents through the stenosis for 1 year. Results Thirty-six patients were included. Technical success was 89% (32/36), with four failures to cross the stenosis but EUS-HGS was performed in 100% of the cases. Nine patients were excluded during calibration because of oncological relapse in six and complex stenosis in three. Three patients had not yet reached 1 year of follow-up. Twenty patients had a calibration for at least 1 year. Clinical success after stent placement was considered in all cases after 1 year of follow-up. Thirteen patients underwent stent removal and no relapse occurred after 435 days of follow-up (SD=568). Global morbidity was 41.7% (15/36) with only one serious complication (needing intensive care), including seven cases of cholangitis due to intrabiliary duct obstruction and five stent migrations. No deaths were reported. Conclusions EUS-BD for calibration in case of benign biliary stenosis is an option. Dedicated materials are needed to decrease morbidity.

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EUS-guided hepaticogastrostomy in the management of malignant biliary obstruction: Experience and learning curve in a tertiary referral center

Cited by 8 publications

References 14 publications

Safety of endoscopic ultrasound-guided hepaticogastrostomy in patients with malignant biliary obstruction and ascites

Safety of endoscopic ultrasound-guided hepaticogastrostomy in patients with malignant biliary obstruction and ascites

Endoscopic Ultrasound-guided Hepaticogastrostomy, Experience in Colombia: Case Series

EUS-BD for calibration of benign stenosis of the bile duct in patients with altered anatomy or inaccessible papilla

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