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Endoscopic Ultrasound-Guided Biliary Drainage: Endoscopic Ultrasound-Guided Hepaticogastrostomy in Malignant Biliary Obstruction
Published on: March 25, 2022
Use of Interventional Radiologically Guided Covered Self-Expanding Metallic Stents for the Treatment of
Caroline Yang1, Hiro Masuda1, Neel Gore2
1Department of Upper Gastrointestinal Surgery, Royal North Shore Hospital, St Leonards, New South Wales, Australia.
Introduction:
To assess the efficacy and safety of interventional radiology-guided covered self-expanding metallic stents (CSEMS) in the management of hepaticojejunostomy (HJ) bile leaks following major hepatic and pancreatic resections.
Methods:
A retrospective study was conducted of all patients who developed HJ bile leaks after hepatic and pancreatic resections between January 2020 and February 2025 at a single tertiary referral centre. Analysis was performed on patients managed with percutaneous, IR-guided CSEMS placement. Patient demographics, clinical presentation, procedural details, stent characteristics and outcomes were collected. The primary endpoint was successful radiological resolution of the bile leak. Secondary endpoints included procedural complications and 90-day mortality.
Results:
Nine patients with HJ leaks were managed with IR-guided CSEMS placement. The index operation was a pancreaticoduodenectomy in 7 of 9 patients and extended hepatectomy with bile duct reconstruction in 2 of 9 patients. The overall success rate for leak resolution was 100%. The median time to radiological resolution was 21.5 days (range, 7-51 days). Complications occurred in 4 of 9 patients, consisting of stent migration in one patient and cholangitis in three patients. No patient required surgical intervention for the HJ leak.
Conclusion:
The use of IR-guided CSEMS for managing HJ bile leaks is a highly effective and minimally invasive treatment. It demonstrates an excellent success rate for leak resolution with a manageable complication profile, representing a reliable alternative to surgical re-intervention in this complex patient population.
