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Updated: Jun 5, 2025

Endoscopic Ultrasound-Guided Biliary Drainage: Endoscopic Ultrasound-Guided Hepaticogastrostomy in Malignant Biliary Obstruction
Published on: March 25, 2022
EUS-directed transduodenal ERCP in concomitant gastric outlet and biliary obstruction
Vivek Kesar1, William F Abel1, Jay Bapaye1
1Division of Gastroenterology, Virginia Tech Carilion, Roanoke, Virginia.
Background And Aims:
Patients with concomitant gastric outlet obstruction (GOO) and biliary obstruction often have limited management options, particularly in the setting of severe debility. We detail the use of EUS-guided gastroduodenal placement of a lumen-apposing metal stent (LAMS) as a conduit for transduodenal ERCP: EUS-directed transduodenal ERCP.
Methods:
Nine patients who developed GOO with indwelling biliary metal stents or with anticipated biliary stent placement were retrospectively included.
Results:
A 20 mm × 10 mm LAMS was deployed for creation of gastroduodenostomy in all patients. ERCP was performed via the gastroduodenal LAMS with resolution of jaundice in 100% of patients. GOO score improved to 3 in all patients.
Conclusions:
This study demonstrates excellent outcomes (resolution of jaundice and GOO) in all chronically ill, poor surgical candidates. Placement of a LAMS allowed for both treatment of GOO and ERCP access for present and future stent exchange.
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