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Updated: May 23, 2025
Endoscopic Ultrasound-Guided Biliary Drainage: Endoscopic Ultrasound-Guided Hepaticogastrostomy in Malignant Biliary Obstruction
Published on: March 25, 2022
Clearing the Path: Redefining Hepatolithiasis Removal Through Endoscopic Hepaticogastrostomy
Woo Suk Kim1, Tasur Seen2, Krishna Gurram2
1Internal Medicine, Icahn School of Medicine at Mount Sinai, Queens, USA.
Insights
Endoscopic ultrasound-guided hepaticogastrostomy offers a less invasive treatment for hepatolithiasis, successfully clearing intrahepatic bile duct stones in a patient who previously failed other endoscopic methods.
Area of Science:
- Gastroenterology
- Hepatology
- Interventional Endoscopy
Background:
- Hepatolithiasis, intrahepatic bile duct stones, presents significant therapeutic challenges.
- Associated complications include recurrent cholangitis, biliary obstruction, hepatic abscesses, and cholangiocarcinoma.
- Conventional treatments like hepatectomy and percutaneous transhepatic cholangioscopic lithotomy (PTCL) are invasive; endoscopic methods may leave residual stones.
Observation:
- An 80-year-old female patient presented with recurrent hepatolithiasis and hepatic abscesses.
- She had not responded to conventional endoscopic treatments for her condition.
Findings:
- Endoscopic ultrasound (EUS)-guided hepaticogastrostomy was successfully performed via a transgastric approach.
- This allowed direct access to intrahepatic stones for clearance, resulting in complete symptomatic relief.
Implications:
- Hepaticogastrostomy presents a less invasive, effective alternative to surgery for hepatolithiasis management.
- This technique serves dual diagnostic and therapeutic roles, potentially improving patient outcomes.
- Further research is warranted to establish the long-term efficacy and optimal role of EUS-guided hepaticogastrostomy in treating hepatolithiasis.
Abstract:
Hepatolithiasis is a condition characterized by the presence of bile stones in the intrahepatic bile ducts. It represents a significant therapeutic challenge owing to its association with recurrent cholangitis, biliary obstruction, and potentially life-threatening complications such as hepatic abscesses and cholangiocarcinoma. Traditional treatments include hepatectomy and percutaneous transhepatic cholangioscopic lithotomy (PTCL), both of which are effective but highly invasive, whereas endoscopic approaches often leave residual stones. We report a case of recurrent hepatolithiasis with abscesses in an 80-year-old woman who had failed to respond to conventional endoscopic approaches. Endoscopic ultrasound (EUS)-guided hepaticogastrostomy was successfully performed through the transgastric approach to allow access to intrahepatic stones for clearance with complete symptomatic relief and no further evidence of recurrence during follow-up. This case demonstrates the use of hepaticogastrostomy as a less invasive alternative to surgery while serving both diagnostic and therapeutic purposes. Further studies are needed to delineate its role as well as its long-term efficacy in the management of hepatolithiasis.
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