CC BY-NC-ND 4.0 · Endosc Int Open 2018; 06(02): E127-E130
DOI: 10.1055/s-0043-123188
Original article
Eigentümer und Copyright ©Georg Thieme Verlag KG 2018

Endoscopic ultrasound-guided hepaticogastrostomy and antegrade clearance of biliary lithiasis in patients with surgically-altered anatomy

Amy Hosmer
1  Division of Gastroenterology & Hepatology, University of Michigan, Ann Arbor, Michigan, United States
,
Mohamed M Abdelfatah
2  Division of Gastroenterology and Hepatology, East Carolina University, Greenville, North Carolina, United States
,
Ryan Law
1  Division of Gastroenterology & Hepatology, University of Michigan, Ann Arbor, Michigan, United States
,
Todd H. Baron
3  Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, North Carolina, United States
› Author Affiliations
Further Information

Publication History

submitted 03 November 2017

accepted after revision 07 November 2017

Publication Date:
01 February 2018 (online)

Abstract

Background and study aims Endoscopic retrograde cholangiography (ERC) in patients with complex surgically-altered anatomy (SAA) is technically demanding and has limitations. Developments in EUS-guided procedures allow alternative approaches for patients with altered gastrointestinal anatomy and biliary lithiasis.

Patients and methods Single-center, retrospective review of prospectively entered patients with SAA who underwent EUS-guided hepaticogastrostomy (HGS) followed by an interval antegrade endoscopic clearance of biliary lithiasis.

Results 9 patients with Roux-en-Y anatomy underwent HGS to allow clearance of biliary lithiasis after a mean of 2.5 procedures. Technical success was achieved in 100 % of patients utilizing subsequent antegrade endoscopic techniques after HGS including: balloon sweep (9), transpapillary balloon dilation (8), cholangioscopy with electrohydraulic lithotripsy (4), and mechanical lithotripsy (1). HGS stents were removed in all patients. 1 adverse event (cholangitis) occurred after cholangioscopy and prolonged intraductal electrohydraulic lithotripsy.

Conclusion EUS-guided antegrade therapy for the management of biliary lithiasis in patients with altered gastrointestinal anatomy appears efficacious with a low risk of adverse events. These preliminary results suggest this approach should be considered at centers with available expertise.