Advanced Eus Guided Bilio-Gastric Anastomosis and Interventions
Refereed conference paper presented and published in conference proceedings


EUS-guided biliary drainages are increasingly performed in patients with failed ERCP. In this video, we describe 3 patients with difficult EUS-biliogastric anastomosis and advanced interventions through the established anastomosis.

Case description
Case 1. A 74 year-old lady presented with upper gastrointestinal bleeding due to a locally advanced pancreatic cancer had failed endoscopic hemostasis requiring surgery. She was complicated by a leak at the duodenotomy site. A percutaneous tube was inserted but continued to cause bile leak from the skin and internalization was not favored due to presence of a duodenal leak. She was scheduled for EUS-guided choledochogastrostomy. The procedure was performed with a forward-viewing echoendoscope. The common bile duct was punctured from the antrum of the stomach using a 22G needle. A 0.018” guidewire was passed into the common bile duct. The track was dilated with a 6Fr cystotome and a 4 x 40 mm balloon. An 8 x 10mm fully covered metallic stent was then inserted with good drainage into the stomach. Case 2 describes a EUS-guided salvage of a mis-deployed HGS stent. EUS-guided HGS was performed in a patient with unresectable gastric cancer with pyloric obstruction. During deployment, the proximal end of the stent was deployed in to the peritoneal cavity. Attempts to insert an additional stent on guidewire to bridge the stent to the stomach resulted in complete dislodgement of the guidewire. The gastrotomy opening was first closed with the over-the scope clip. The proximal edge of the mis-deployed metallic stent was identified outside of the stomach by a linear echoendoscope. The opening of the stent was punctured with a 19G needle. A 0.025” guidewire was passed into the common bile duct. The tk was then dilated with a 6Fr cystotome and a 4 x 40 mm balloon. A 10 x 80mm fully covered metal stent were inserted to bridge the stomach to the bile duct. Case 3 describes a patient with 2-staged endoscopic recanalization of an stenosed surgical hepaticojejunostomy for benign distal biliary stricture via a EUS-guided HGS. In the first stage, a EUS-guided HGS was performed through the left intrahepatic duct and a 10 x 80mm fully covered metallic stent was placed. The video describes the 2nd stage of the procedure where endoscopic recanalization of the surgical hepaticojejunostomy was performed a few months later. Cholangioscopic examination through the HGS found a completely stenosed hepaticojejunostomy. A needle was then used to puncture the anastomosis and entered the jejunum as confirmed by contrast injection and guidewire insertion. The stenosed hepticojejunostomy was then dilated with a 6Fr cystotome. An 8.5 Fr 15cm double pigtail plastic stent was then inserted.

Advanced bilio-gastric anastomoses and interventions were feasible and successfully avoided surgical interventions in these patients.
著者Teoh AY, Yip HC, Chan SM, Wong VW, Chiu PWYW, Ng EK
會議名稱Digestive Disease Week 2017
會議地點Chicago, Illinois
會議論文集題名Gastrointestinal Endoscopy
期次5 Supplement
頁次AB113 - AB113
Web of Science 學科類別Gastroenterology & Hepatology;Gastroenterology & Hepatology

上次更新時間 2020-05-08 於 02:50