Endoscopic ultrasonography-guided hepaticogastrostomy

Area of Science:

• Gastroenterology
• Interventional Endoscopy
• Biliary Interventions

Background:

• Percutaneous transhepatic biliary drainage (PTBD) is the standard biliary access following failed endoscopic retrograde cholangiopancreatography (ERCP).
• Endoscopic ultrasonography (EUS)-guided biliary drainage (EUS-BD) has emerged as a potential alternative, particularly for cases requiring internal drainage.

Purpose of the Study:

• To review the indications, techniques, and outcomes of EUS-guided hepaticogastrostomy (EUS-HG).
• To evaluate EUS-HG as an alternative to PTBD after failed ERCP.

Main Methods:

• Systematic review of published data on EUS-guided hepaticogastrostomy.
• Analysis of case reports and studies detailing EUS-BD techniques and outcomes.

Main Results:

• EUS-guided biliary drainage (EUS-BD) offers internal drainage, circumventing the need for long-term external catheters associated with PTBD.
• EUS-guided hepaticogastrostomy (EUS-HG) is a specific EUS-BD technique with reported success in managing biliary obstruction post-ERCP failure.

Conclusions:

• EUS-guided hepaticogastrostomy (EUS-HG) presents a viable alternative to PTBD for biliary access after failed ERCP.
• EUS-HG may offer advantages in achieving internal biliary drainage, improving patient management and comfort.