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EUS-guided biliary drainage for internalization of percutaneous transhepatic biliary drainage
VIDEO
EUS-guided biliary drainage for internalization of percutaneous transhepatic biliary drainage
Figure 1. A, Injection of water-soluble contrast medium through the percutaneous drain, demonstrating complete obstruction at the left main hepatic duct. B, EUS-guided puncture of a dilated biliary radicle in segment II of the liver. C, Deployment of the distal stent into the peripheral hepatic duct under endosonographic guidance. D, Final fluoroscopic image demonstrating successful hepaticogastrostomy with use of a prototype self-expandable metal stent and double-pigtail plastic stent. E, Final endoscopic image demonstrating successful hepaticogastrostomy with use of a prototype selfexpandable metal stent and double-pigtail plastic stent. F, The percutaneous catheter was injected to demonstrate successful internalization of biliary drainage by EUS-guided hepaticogastrostomy.
The interventional potential of EUS continues to evolve, most notably in techniques for EUS-guided biliary drainage (EUS-BD). In skilled hands, EUS-BD can provide access to the biliary tree in patients with an inaccessible papilla or surgically altered luminal anatomy, or in those with biliary obstruction and prior incomplete biliary drainage after ERCP. Emerging data suggest that EUS-BD can be performed to provide internalization of biliary drainage in patients who have previously undergone percutaneous transhepatic biliary drainage (PTBD).
A 59-year-old man with stage IV colorectal cancer with extensive metastatic disease to his liver and right lung underwent EUS-guided internalization of his PTBD by use of an EUS-guided hepaticogastrostomy (EUS-HGS) approach. After diagnosis, he underwent sigmoidectomy and subsequently a right hepatectomy. More recently, he experienced a high-grade biliary obstruction at the level of the left main hepatic duct. The patient underwent PTBD for decompression. Two attempts at internalization of biliary drainage with ERCP were unsuccessful. He was then referred for EUS-HGS to internalize his
Written transcript of the video audio is available online at www.VideoGIE.org.
www.VideoGIE.org
Volume
-,
No.
-
: 2017 VIDEOGIE 1
Video
percutaneous biliary drainage catheter (Video available online at www.VideoGIE.org; Fig. 1).
1,
DISCLOSURE Dr Perez-Miranda is a consultant for Boston Scientific, W. L. Gore, and M. I. Tech. All other authors disclosed no financial relationships relevant to this publication.
2 VIDEOGIE Volume
-,
No.
-
: 2017
Ryan Law, DO, Division of Gastroenterology, University of Michigan, Ann Arbor, Michigan, USA, Ramon Sanchez-Ocana Hernandez, MD, Carlos de la Serna-Higuera, MD, Manuel Perez-Miranda, MD, PhD, Gastroenterology Department, Hospital Universitario Rio Hortega, Valladolid, Spain Copyright ª 2017 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). http://dx.doi.org/10.1016/j.vgie.2017.06.011
www.VideoGIE.org
EUS-guided biliary drainage for internalization of percutaneous transhepatic biliary drainage
Figure 1. A, Injection of water-soluble contrast medium through the percutaneous drain, demonstrating complete obstruction at the left main hepatic duct. B, EUS-guided puncture of a dilated biliary radicle in segment II of the liver. C, Deployment of the distal stent into the peripheral hepatic duct under endosonographic guidance. D, Final fluoroscopic image demonstrating successful hepaticogastrostomy with use of a prototype self-expandable metal stent and double-pigtail plastic stent. E, Final endoscopic image demonstrating successful hepaticogastrostomy with use of a prototype selfexpandable metal stent and double-pigtail plastic stent. F, The percutaneous catheter was injected to demonstrate successful internalization of biliary drainage by EUS-guided hepaticogastrostomy.
The interventional potential of EUS continues to evolve, most notably in techniques for EUS-guided biliary drainage (EUS-BD). In skilled hands, EUS-BD can provide access to the biliary tree in patients with an inaccessible papilla or surgically altered luminal anatomy, or in those with biliary obstruction and prior incomplete biliary drainage after ERCP. Emerging data suggest that EUS-BD can be performed to provide internalization of biliary drainage in patients who have previously undergone percutaneous transhepatic biliary drainage (PTBD).
A 59-year-old man with stage IV colorectal cancer with extensive metastatic disease to his liver and right lung underwent EUS-guided internalization of his PTBD by use of an EUS-guided hepaticogastrostomy (EUS-HGS) approach. After diagnosis, he underwent sigmoidectomy and subsequently a right hepatectomy. More recently, he experienced a high-grade biliary obstruction at the level of the left main hepatic duct. The patient underwent PTBD for decompression. Two attempts at internalization of biliary drainage with ERCP were unsuccessful. He was then referred for EUS-HGS to internalize his
Written transcript of the video audio is available online at www.VideoGIE.org.
www.VideoGIE.org
Volume
-,
No.
-
: 2017 VIDEOGIE 1
Video
percutaneous biliary drainage catheter (Video available online at www.VideoGIE.org; Fig. 1).
1,
DISCLOSURE Dr Perez-Miranda is a consultant for Boston Scientific, W. L. Gore, and M. I. Tech. All other authors disclosed no financial relationships relevant to this publication.
2 VIDEOGIE Volume
-,
No.
-
: 2017
Ryan Law, DO, Division of Gastroenterology, University of Michigan, Ann Arbor, Michigan, USA, Ramon Sanchez-Ocana Hernandez, MD, Carlos de la Serna-Higuera, MD, Manuel Perez-Miranda, MD, PhD, Gastroenterology Department, Hospital Universitario Rio Hortega, Valladolid, Spain Copyright ª 2017 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). http://dx.doi.org/10.1016/j.vgie.2017.06.011
www.VideoGIE.org