Unusual complications following endoscopic ultrasound-guided hepaticogastrostomy: A call for refined techniques and dedicated devices

doi:10.3748/wjg.v31.i43.113186

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Nov 21, 2025 (publication date) through Nov 20, 2025

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World Journal of Gastroenterology

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1007-9327

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Letter to the Editor

World J Gastroenterol. Nov 21, 2025; 31(43): 113186
Published online Nov 21, 2025. doi: 10.3748/wjg.v31.i43.113186

Unusual complications following endoscopic ultrasound-guided hepaticogastrostomy: A call for refined techniques and dedicated devices

Jin Ho Choi, Woo Hyun Paik

Jin Ho Choi, Woo Hyun Paik, Department of Internal Medicine and Liver Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 03080, South Korea

Author contributions: Paik WH and Choi JH wrote and revised the manuscript.

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 that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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: https://creativecommons.org/Licenses/by-nc/4.0/

Corresponding author: Woo Hyun Paik, MD, PhD, Professor, Department of Internal Medicine and Liver Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Daehak-ro 101, Seoul 03080, South Korea. iatrus@snu.ac.kr

Received: August 19, 2025
Revised: September 23, 2025
Accepted: October 20, 2025
Published online: November 21, 2025
Processing time: 94 Days and 1.2 Hours

Core Tip

Core Tip: Unusual complications following endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) underscore the need for careful attention to technique and device choice. Although plastic stents are still used, fully covered self-expandable metal stents may better prevent bile leakage. Additionally, the choice of puncture site, such as segment 2 vs segment 3, and the method of fistula dilation critically influence outcomes. This editorial highlights the importance of refining EUS-HGS techniques and developing dedicated devices to enhance safety and reduce unexpected complications.