EUS-guided hepaticogastrostomy with a fully covered metal stent as the biliary diversion technique for an occluded biliary metal stent after a failed ERCP (with videos).
BACKGROUND
Percutaneous transhepatic biliary drainage (PTBD) may be the last resort for an occluded biliary metal stent when the ERCP was unsuccessful.


OBJECTIVE
Because an EUS-guided biliary drainage has been proposed as an effective alternative for PTBD after a failed ERCP, we conducted this study to determine the feasibility and usefulness of an EUS-guided hepaticogastrostomy (EUS-HG) with a fully covered self-expandable metal stent (FCSEMS) for an occluded biliary metal stent after a failed ERCP.


METHODS
A case study.


METHODS
A tertiary referral center.


METHODS
Five patients who had an occluded biliary metal stent inserted after a hilar bilateral metal stent or a combined duodenal and biliary metal stent insertion and for whom reinterventional ERCP was unsuccessful underwent an EUS-HG with an FCSEMS for alternative PTBD.


METHODS
Technical and functional success, procedural complications, reinterventional rate after EUS-HG with an FCSEMS, and short-term stent patency.


RESULTS
In all 5 patients, an EUS-HG with an FCSEMS was technically successful. No procedural complications, such as bile peritonitis, cholangitis, and pneumoperitoneum, were observed. Functional success was also 100% (5/5). During the follow-up period (median 152 days, range 64-184 days), no late complications, such as stent migration and occlusion, were observed. Thus, no biliary reintervention was performed during the follow-up period.


CONCLUSIONS
A small series of patients without a control group.


CONCLUSIONS
The EUS-HG with an FCSEMS may be feasible, effective, and an alternative PTBD for an occluded biliary metal stent after a failed ERCP.
Park
Do Hyun
DH
Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.
Song
Tae-Jun
TJ
Eum
Junbum
J
Moon
Sung-Hoon
SH
Lee
Sang Soo
SS
Seo
Dong-Wan
DW
Lee
Sung-Koo
SK
Kim
Myung-Hwan
MH
D000368:Aged; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods; D002780:Cholestasis, Intrahepatic / Q000000981:diagnostic imaging / Q000601:surgery*; D020878:Device Removal; D004322:Drainage / Q000295:instrumentation; D019160:Endosonography / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D005774:Gastrostomy / Q000379:methods*; D006801:Humans; D008099:Liver / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010166:Palliative Care; D011475:Prosthesis Failure; D011788:Quality of Life; D018570:Risk Assessment; D012494:Sampling Studies; D015607:Stents; D016896:Treatment Outcome; D014741:Video Recording