Clinical Endoscopy

The Korean Society of Gastrointestinal Endoscopy (대한소화기내시경학회)
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Safety of endoscopic ultrasound-guided hepaticogastrostomy in patients with malignant biliary obstruction and ascites

  • Tsukasa Yasuda (Department of Gastroenterology, Aichi Cancer Center Hospital) ;
  • Kazuo Hara (Department of Gastroenterology, Aichi Cancer Center Hospital) ;
  • Nobumasa Mizuno (Department of Gastroenterology, Aichi Cancer Center Hospital) ;
  • Shin Haba (Department of Gastroenterology, Aichi Cancer Center Hospital) ;
  • Takamichi Kuwahara (Department of Gastroenterology, Aichi Cancer Center Hospital) ;
  • Nozomi Okuno (Department of Gastroenterology, Aichi Cancer Center Hospital) ;
  • Yasuhiro Kuraishi (Department of Gastroenterology, Aichi Cancer Center Hospital) ;
  • Takafumi Yanaidani (Department of Gastroenterology, Aichi Cancer Center Hospital) ;
  • Sho Ishikawa (Department of Gastroenterology, Aichi Cancer Center Hospital) ;
  • Masanori Yamada (Department of Gastroenterology, Aichi Cancer Center Hospital) ;
  • Toshitaka Fukui (Department of Gastroenterology, Aichi Cancer Center Hospital)
  • Received : 2023.03.05
  • Accepted : 2023.05.11
  • Published : 2024.03.30
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Abstract

Background/Aims: Endoscopic ultrasound (EUS)-guided hepaticogastrostomy (EUS-HGS) is useful for patients with biliary cannulation failure or inaccessible papillae. However, it can lead to serious complications such as bile peritonitis in patients with ascites; therefore, development of a safe method to perform EUS-HGS is important. Herein, we evaluated the safety of EUS-HGS with continuous ascitic fluid drainage in patients with ascites. Methods: Patients with moderate or severe ascites who underwent continuous ascites drainage, which was initiated before EUS-HGS and terminated after the procedure at our institution between April 2015 and December 2022, were included in the study. We evaluated the technical and clinical success rates, EUS-HGS-related complications, and feasibility of re-intervention. Results: Ten patients underwent continuous ascites drainage, which was initiated before EUS-HGS and terminated after completion of the procedure. Median duration of ascites drainage before and after EUS-HGS was 2 and 4 days, respectively. Technical success with EUS-HGS was achieved in all 10 patients (100%). Clinical success with EUS-HGS was achieved in 9 of the 10 patients (90%). No endoscopic complications such as bile peritonitis were observed. Conclusions: In patients with ascites, continuous ascites drainage, which is initiated before EUS-HGS and terminated after completion of the procedure, may prevent complications and allow safe performance of EUS-HGS.

Keywords

References

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