Risks of transesophageal endoscopic ultrasonography-guided biliary drainage

Abstract

Summary of Event: Pneumoderma, mediastinal emphysema, and bilateral pneumothorax were developed in the patient who had undergone transesophageal endoscopic ultrasonography-guided rendezvous technique. Chest drainage was performed immediately. Teaching Point: Transesophageal approach carries the potential risks of severe complications such as mediastinal emphysema, mediastinitis, and pneumothorax. To prevent puncturing through the esophagus, clipping the esophagogastric junction using a forward-viewing scope before procedure is very useful. In cases of inadvertent transesophageal puncture, devices other than the needle should not be passed through the site.

Outcomes of Endoscopic Ultrasound-Guided Biliary Drainage in Patients Undergoing Antithrombotic Therapy

“…We have experienced severe adverse events, such as mediastinal emphysema and pneumothorax, when performing transesophageal EUS-guided rendezvous. 9 We were able to easily confirm the position of the clip under fluoroscopy. We attached a connector (Radifocus ® Hemostasis Valve II; Terumo, Tokyo, Japan) to a needle in advance.…”

Efficacy of the 6‐mm fully covered self‐expandable metal stent during endoscopic ultrasound‐guided hepaticogastrostomy as a primary biliary drainage for the cases estimated difficult endoscopic retrograde cholangiopancreatography: A prospective clinical study

“…First, we performed clipping of the esophago‐gastric junction to allow its easy identification and hence prevention of puncture of the esophagus, using a forward‐viewing scope (GIF‐H260, Olympus Optical Co., Ltd.). Because we experienced the serious adverse events such as mediastinal emphysema and pneumothorax when we performed trans‐esophageal EUS‐RV . We could easily confirm the position of the clip under fluoroscopy.…”

What You Need to Know Before Performing Endoscopic Ultrasound-guided Hepaticogastrostomy

“…2 ) [ 15 ]. Although the scope position is straight and guidewire manipulation is easier in segment 2, the puncture site is usually located in the esophagus, increasing the risk of mediastinitis or pneumomediastinum [ 16 ]. Thus, puncturing segment 3 is preferred [ 10 ].…”

“…Thus, puncturing segment 3 is preferred [ 10 ]. A hemoclip can be applied at the esophagogastric junction before EUS examination to avoid puncturing through the esophagus [ 16 ]. To obtain EUS images of segment 3, the scope is usually pushed down into the gastric cardia with upward angulation toward the liver hilum.…”

“…15 Although the scope position is straight and guidewire manipulation is easier in segment 2, the puncture site is usually located in the esophagus, increasing the risk of mediastinitis or pneumomediastinum. 16 Thus, puncturing segment 3 is preferred. 10 A hemoclip can be applied at the esophagogastric junction before EUS examination to avoid puncturing through the esophagus.…”