How to Salvage a Mis-Deployed EUS-Guided Hepaticogastrostomy Stent
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AbstractEndoscopic retrograde cholangio-pancreatography (ERCP) and self-expandable metallic stent (SEMS) insertion have been the preferred mode of biliary drainage in patients suffering from malignant distal biliary obstruction [1, 2]. However, transpapillary access can be difficult in patients with gastric outlet obstruction or surgically altered anatomy. Traditionally, these patients would be managed by percutaneous biliary drainage that is associated with drain-associated morbidities. To avoid this, EUS-guided biliary drainage (EUS-BD) is increasingly performed as an alternative to percutaneous drainage in patients with malignant biliary obstruction that are not amenable to ERCP or had failed ERCP. A meta-analysis of EUS-BD showed significantly better clinical success, lower rate of post-procedure adverse events, and fewer re-interventions as compared with percutaneous biliary drainage in patients with distal biliary obstruction and when ERCP failed [3]. In addition, EUS-BD was found to have comparable technical and clinical success rates as compared to ERCP for malignant biliary obstruction [4, 5]. As with any endoscopic procedure, adverse events (AE) can occur during EUS-BD and rates of up to 23% have been reported for EUS-guided hepaticogastrostomy (HGS) [6]. In the current case, we described our technique of salvaging a mis-deployed HGS stent with the lost of guidewire access.
All Author(s) ListHon Chi Yip, Anthony Y. B. Teoh
All Editor(s) ListAnthony Y.B. Teoh, Marc Giovaninni, Mouen A. Khashab, Takao Itoi
Book titleAtlas of Interventional EUS: Case-based Strategies
Place of PublicationSingapore
Pages307 - 311
LanguagesEnglish-United States

Last updated on 2024-27-02 at 16:17