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World J Gastroenterol. Apr 21, 2016; 22(15): 3945-3951
Published online Apr 21, 2016. doi: 10.3748/wjg.v22.i15.3945
Technical tips for endoscopic ultrasound-guided hepaticogastrostomy
Takeshi Ogura, Kazuhide Higuchi
Takeshi Ogura, Kazuhide Higuchi, Second Department of Internal Medicine, Osaka Medical College, Osaka 569-8686, Japan
Author contributions: Ogura T and Higuchi K equally contributed to this paper.
Conflict-of-interest statement: There is no conflict of interest associated with any of the senior author or other coauthors contributed their efforts in this manuscript.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Takeshi Ogura, MD, PhD, Second Department of Internal Medicine, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki, Osaka 569-8686, Japan. oguratakeshi0411@yahoo.co.jp
Telephone: +81-72-6831221 Fax: +81-72-6846532
Received: December 22, 2015
Peer-review started: December 24, 2015
First decision: January 28, 2016
Revised: January 29, 2016
Accepted: March 1, 2016
Article in press: March 2, 2016
Published online: April 21, 2016
Processing time: 103 Days and 2.6 Hours
Abstract

Interventional procedures using endoscopic ultrasound (EUS) have recently been developed. For biliary drainage, EUS-guided trans-luminal drainage has been reported. In this procedure, the transduodenal approach for extrahepatic bile ducts is called EUS-guided choledochoduodenostomy, and the transgastric approach for intrahepatic bile ducts is called EUS-guided hepaticogastrostomy (EUS-HGS). These procedures have several effects, such as internal drainage and avoiding post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis, and they are indicated for an inaccessible ampulla of Vater due to duodenal obstruction or surgical anatomy. EUS-HGS has particularly wide indications and clinical impact as an alternative biliary drainage method. In this procedure, it is necessary to dilate the fistula, and several devices and approaches have been reported. Stent selection is also important. In previous reports, the overall technical success rate was 82% (221/270), the clinical success rate was 97% (218/225), and the overall adverse event rate for EUS-HGS was 23% (62/270). Adverse events of EUS-biliary drainage are still high compared with ERCP or PTCD. EUS-HGS should continue to be performed by experienced endoscopists who can use various strategies when adverse events occur.

Keywords: Endoscopic ultrasound; Endoscopic ultrasound-guided hepaticogastrostomy; Endoscopic ultrasound-guided biliary drainage; Endoscopic retrograde cholangiopancreatography

Core tip: Endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) has been developed as an alternative biliary drainage method. The reported technical success rate of EUS-HGS ranges from 65% to 100%, and the clinical success rate ranges from 87% to 100%. Furthermore, the overall technical success rate was 82%, and the overall clinical success rate was 97%. Based on the currently available literature, the overall adverse event rate for EUS-HGS is 23%. EUS-HGS has high rate of adverse events that are sometimes fatal. Therefore, EUS-HGS should continue to be performed by experienced endoscopists who can use various strategies when adverse events occur.