Abstract
Endoscopic ultrasound-guided hepaticogastrostomy (EUS-HG) is a technique used to access the biliary tree in patients with surgically altered anatomy. Additionally, development of EUS-HG fistula permits intraductal therapy, thereby preventing patients from requiring surgery or percutaneous transhepatic biliary drainage (PTBD), thus decreasing morbidity. This clinical vignette describes an 83-year-old man with a history of gangrenous cholecystitis requiring cholecystectomy, partial gastrectomy, and Roux-en-Y gastrojejunostomy who presented to an outside hospital with abdominal pain and fever and found to have cholangitis and choledocholithiasis. He underwent two endoscopic retrograde cholangiopancreatography (ERCP) procedures at an outside hospital which were unsuccessful due to an inaccessible major papilla in the setting of the patient's surgically altered anatomy. On arrival to Wake Forest, the patient underwent EUS-HG with successful biliary drainage and resolution of cholangitis. He returned for ERCP three months later with balloon sphincteroplasty, cholangioscopy, and electrohydraulic lithotripsy (EHL) performed through the existing metal stent (hepaticogastrostomy), resulting in stone fragmentation and antegrade removal with balloon sweeps. Repeat cholangioscopy post-EHL and balloon sweeps showed complete duct clearance with no residual stones. The hepaticogastrostomy stent was subsequently removed, and the patient recovered without any complications.
Highlights
Endoscopic retrograde cholangiography (ERCP) is the cornerstone of accessing the biliary tree in patients requiring biliary drainage [1]
Advances in the field of endoscopy have allowed for the development of novel techniques like endoscopic ultrasound-guided hepaticogastrostomy (EUSHG), which provides patients with a safer and less-invasive option
Endoscopic ultrasound-guided hepaticogastrostomy (EUS-HG) involves the creation of a fistula between the stomach and the hepatic duct to access the biliary tree [2]. rough this gastrohepatic tract, ERCP can be performed for the diagnosis and management of biliary pathology [3]. is clinical vignette describes a patient with surgically altered gastrointestinal anatomy (SAGA) and subsequent successful treatment of choledocholithiasis and cholangitis via EUS-HG, cholangioscopy with electrohydraulic lithotripsy (EHL), and antegrade clearance of bile duct stones into the duodenum
Summary
Received 15 September 2020; Revised 25 September 2020; Accepted 2 November 2020; Published 12 November 2020. Is clinical vignette describes an 83-year-old man with a history of gangrenous cholecystitis requiring cholecystectomy, partial gastrectomy, and Roux-en-Y gastrojejunostomy who presented to an outside hospital with abdominal pain and fever and found to have cholangitis and choledocholithiasis He underwent two endoscopic retrograde cholangiopancreatography (ERCP) procedures at an outside hospital which were unsuccessful due to an inaccessible major papilla in the setting of the patient’s surgically altered anatomy. On arrival to Wake Forest, the patient underwent EUS-HG with successful biliary drainage and resolution of cholangitis He returned for ERCP three months later with balloon sphincteroplasty, cholangioscopy, and electrohydraulic lithotripsy (EHL) performed through the existing metal stent (hepaticogastrostomy), resulting in stone fragmentation and antegrade removal with balloon sweeps. Repeat cholangioscopy post-EHL and balloon sweeps showed complete duct clearance with no residual stones. e hepaticogastrostomy stent was subsequently removed, and the patient recovered without any complications
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