Endoscopy 2021; 53(05): E196-E197
DOI: 10.1055/a-1226-6301
E-Videos

Endoscopic ultrasound-guided hepaticogastrostomy combined with gastroenterostomy in a case of complete duodenal obstruction

Shupeng Wang
Department of Gastroenterology, Shengjing Hospital of China Medical University, Shenyang, China
,
Jintao Guo
Department of Gastroenterology, Shengjing Hospital of China Medical University, Shenyang, China
,
Nan Ge
Department of Gastroenterology, Shengjing Hospital of China Medical University, Shenyang, China
,
Sheng Wang
Department of Gastroenterology, Shengjing Hospital of China Medical University, Shenyang, China
,
Wen Liu
Department of Gastroenterology, Shengjing Hospital of China Medical University, Shenyang, China
,
Siyu Sun
Department of Gastroenterology, Shengjing Hospital of China Medical University, Shenyang, China
› Author Affiliations

We report a successful case of hepaticogastrostomy combined with gastroenterostomy guided by endoscopic ultrasound (EUS) in a patient with unresectable carcinoma of the pancreatic head.

A 70-year-old woman presented with jaundice and vomiting for 3 weeks because of carcinoma of the pancreatic head. Attempts to implant a conventional intraluminal stent had failed three times owing to duodenal complete obstruction (twice at the previous hospital and once at our hospital). Therefore, we attempted EUS-guided hepaticogastrostomy and gastroenterostomy.

Because of poor function of the liver and disordered coagulation, we firstly performed hepaticogastrostomy as follows: (1) the intrahepatic bile duct (B3) was punctured with a 19-gauge needle; (2) a 0.035-inch guidewire was inserted; (3) the path was dilated with a 6-Fr cystotome; (4) a fully covered metal stent was implanted ([Video 1], part 1); and (5) a gastric tube was placed for external bile drainage. After 5 days, we performed a gastroenterostomy as follows: (1) following puncture, a 0.035-inch guidewire was inserted into jejunum; (2) enough saline was injected to display the proximal jejunum; and (3) a double-flanged fully covered metal stent with a cautery tip was implanted ([Video 1], part 2).

Video 1 Endoscopic ultrasound-guided hepaticogastrostomy combined with gastroenterostomy for complete duodenal obstruction.


Quality:

The stents functioned well until the patient developed vomiting in the third month after the operation. A computed tomography (CT) scan showed that the flange of the stent in the stomach had migrated. We implanted a new stent successfully, but the patient died owing to cerebral infarction a few days later.

To the best of our knowledge, this is the first report of hepaticogastrostomy combined with gastroenterostomy in a case of complete duodenal obstruction. Compared with previous reports [1] [2], the completely obstructed duodenum in the present case significantly increased the difficulty of the gastroenterostomy procedure, as it prevented the use of a balloon catheter or ultrafine gastroscope. Hepaticogastrostomy combined with gastroenterostomy produced a satisfactory effect, but the migration of the fully covered stent should be noted and any necessary intervention should be performed promptly [3] [4] [5].

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Publication History

Article published online:
02 September 2020

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  • References

  • 1 Iqbal U, Khara HS, Hu Y. et al. EUS-guided gastroenterostomy for the management of gastric outlet obstruction: A systematic review and meta-analysis. Endosc Ultrasound 2020; 9: 16-23
  • 2 Mahler MA, Prieto RG, Oria I. et al. Single-session EUS-guided hepaticogastrostomy and dual-scope gastroenterostomy: a modified technique for palliative double endoscopic biliary and gastric bypass. Endoscopy 2018; 50: 78-79
  • 3 Giovannini M. EUS-guided hepaticogastrostomy. Endosc Ultrasound 2019; 8: S35-S39
  • 4 Fujisawa T, Saito H, Isayama H. Endoscopic removal of a metal stent that migrated into the peritoneal cavity after endoscopic ultrasound-guided hepaticogastrostomy. Dig Endosc 2019; 31: e74-e75
  • 5 Siddiqui UD, Levy MJ. EUS-guided transluminal interventions. Gastroenterology 2018; 154: 1911-1924