Clinical Endoscopy

The Korean Society of Gastrointestinal Endoscopy (대한소화기내시경학회)
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Endoscopic ultrasound-guided hepaticogastrostomy by puncturing both B2 and B3: a single center experience

  • Moaz Elshair (Department of Gastroenterology, Aichi Cancer Center Hospital) ;
  • Kazuo Hara (Department of Gastroenterology, Aichi Cancer Center Hospital) ;
  • Nozomi Okuno (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) ;
  • Asmaa Bakr (Department of Gastroenterology, Aichi Cancer Center Hospital) ;
  • Abdou Elshafei (Department of Hepatology, Gastroenterology and Infectious Diseases, Faculty of Medicine, Al-Azhar University) ;
  • Mohamed Z. Abu-Amer (Department of Hepatology, Gastroenterology and Infectious Diseases, Faculty of Medicine, Al-Azhar University)
  • Received : 2022.08.12
  • Accepted : 2022.11.23
  • Published : 2024.07.30
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Abstract

Endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) through ducts B2 or B3 is effective in most patients with biliary obstruction, because B2 and B3 commonly join together. However, in some patients, B2 and B3 do not join each other due to invasive hilar tumors; therefore, single-route drainage is insufficient. Here, we investigated the feasibility and efficacy of EUS-HGS through both B2 and B3 simultaneously in seven patients. We decided to perform EUS-HGS through both B2 and B3 to achieve adequate biliary drainage because these two ducts were separate from each other. Here, we report a 100% technical and overall clinical success rate. Early adverse effects were closely monitored. Minimal bleeding was reported in one patient (1/7) and mild peritonitis in one patient (1/7). None of the patients experienced stent dysfunction, fever, or bile leakage after the procedure. EUS-HGS through both B2 and B3 simultaneously is safe, feasible, and effective for biliary drainage in patients with separated ducts.

Keywords

Acknowledgement

The authors are thankful to Prof. Kenneth Tanabe and Dr. Ibrahim Essa at the Surgery Department, Massachusetts General Hospital, Harvard Medical School, for their critical reading of our manuscript.

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