Conversion of endoscopic ultrasound-guided hepaticogastrostomy to transpapillary drainage by anterograde intervention via dedicated biliary metal stent for benign biliary stenosis.

Abstract

An 80-year-old woman with obstructive jaundice caused by distal biliary stenosis secondary to chronic pancreatitis was referred for biliary drainage. After failed endoscopic retrograde cholangiopancreatography, endoscopic ultrasound (EUS)guided biliary drainage was proposed. Portal cavernomatosis prevented an extrahepatic route and EUS-hepaticogastrostomy (HGS) was considered. Using a linear echoendoscope, the left biliary duct was accessed with a 19‐gauge needle. The tract diameter was increased using a 6-Fr cystotome and 4-mm balloon catheter. A partially covered biliary self-expandable metal stent (SEMS; 8 ×80mm Niti-S Giobor stent; Taewoong Medical, Goyang-si, South Korea) was placed (▶Fig. 1). Endoscopic anterograde transhepatic intervention was attempted 6 weeks later through the mature EUS-HGS fistula. Anterograde cholangioscopy using a pediatric scope through the transhepatic SEMS showed tissue ingrowth at the uncovered end (2.4 cm), occluding the distal stent lumen. The Giobor stent was E-Videos