Clinical Endoscopy

Outcomes of partially covered self-expandable metal stents with different uncovered lengths in endoscopic ultrasound-guided hepaticogastrostomy: a Japanese retrospective study: Takeshi Okamoto, Takashi Sasaki, Tsuyoshi Takeda, Tatsuki Hirai, Takahiro Ishitsuka, Manabu Yamada, Hiroki Nakagawa, Takafumi Mie, Takaaki Furukawa, Akiyoshi Kasuga, Masato Ozaka, Naoki Sasahira; Clin Endosc 2024;57(4):515-526. Published online May 10, 2024; DOI: https://doi.org/10.5946/ce.2023.142

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Background
/Aims: The optimal length of the uncovered portion of partially covered self-expandable metal stents (PCSEMSs) used in endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) remains unclear. This study investigated the safety and efficacy of PCSEMSs with different uncovered lengths, with a focus on stent migration and time to recurrent biliary obstruction (RBO).
Methods
Outcomes of patients undergoing EUS-HGS using PCSEMSs with 5-mm and 20-mm uncovered portions at our institution from January 2016 to December 2021 were compared.
Results
Sixty-two patients underwent EUS-HGS using PCSEMS (5/20-mm uncovered portions: 32/30). Stent migration occurred only in the 5-mm group. There were no differences in RBO rates (28.1% vs. 40.0%) or median time to RBO (6.8 vs. 7.1 months) between the two groups. Median overall survival (OS) was longer in the 20-mm group (3.1 vs. 4.9 months, p=0.037) due to the higher number of patients that resumed chemotherapy after EUS-HGS (56.7% vs. 28.1%, p=0.029). Good performance status, absence of hepatic metastases, and chemotherapy after EUS-HGS were independent predictors of longer OS.
Conclusions
No migration was observed in patients treated with PCSEMS with 20-mm uncovered portions. Patients treated with PCSEMS with 20-mm uncovered portions performed at least as well as those treated with 5-mm uncovered portions in all material respects.

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Migration of covered expandable metal stents after endoscopic ultrasound-guided hepaticogastrostomy: stent covering versus stent design?
Todd H. Baron
Clinical Endoscopy.2024; 57(4): 471. CrossRef

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What You Need to Know Before Performing Endoscopic Ultrasound-guided Hepaticogastrostomy: Tanyaporn Chantarojanasiri, Thawee Ratanachu-Ek, Nonthalee Pausawasdi; Clin Endosc 2021;54(3):301-308. Published online May 28, 2021; DOI: https://doi.org/10.5946/ce.2021.103

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Endoscopic retrograde cholangiopancreatography (ERCP) is the primary treatment modality for bile duct obstruction. When ERCP is unsuccessful, percutaneous transhepatic biliary drainage can be an alternative method. Endoscopic ultrasound-guided biliary drainage (EUS-BD) has emerged as a treatment option for biliary obstruction, especially after ERCP failure. EUS-BD offers transluminal intrahepatic and extrahepatic drainage through a transgastric and transduodenal approach. EUS-guided hepaticogastrostomy (EUS-HGS) is an excellent choice for patients with hilar strictures or those with a surgically altered anatomy. The optimal steps in EUS-HGS are case selection, bile duct visualization, puncture-site selection, wire insertion and manipulation, tract dilation, and stent placement. Caution should be taken at each step to prevent complications. Dedicated devices for EUS-HGS have been developed to improve the technical success rate and reduce complications. This technical review focuses on the essential practical points at each step of EUS-HGS.

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Use of a novel screw-type dilator for endoscopic ultrasonography-guided hepaticogastrostomy via 22-gauge needle and 0.018-inch guidewire.
Shin Kato, Mariko Tsukamoto, Taichi Murai, Yuta Koike
Revista Española de Enfermedades Digestivas.2024;[Epub] CrossRef
Transbulbäre und transgastrale Gallengangsdrainage
Philipp Thies, Markus Dollhopf
Gastroenterologie up2date.2024; 20(01): 69. CrossRef
Safety of endoscopic ultrasound-guided hepaticogastrostomy in patients with malignant biliary obstruction and ascites
Tsukasa Yasuda, Kazuo Hara, Nobumasa Mizuno, Shin Haba, Takamichi Kuwahara, Nozomi Okuno, Yasuhiro Kuraishi, Takafumi Yanaidani, Sho Ishikawa, Masanori Yamada, Toshitaka Fukui
Clinical Endoscopy.2024; 57(2): 246. CrossRef
Risk factors for recurrent stenosis after balloon dilation for benign hepaticojejunostomy anastomotic stricture
Takafumi Mie, Takashi Sasaki, Takeshi Okamoto, Tsuyoshi Takeda, Chinatsu Mori, Yuto Yamada, Takaaki Furukawa, Akiyoshi Kasuga, Masato Matsuyama, Masato Ozaka, Naoki Sasahira
Clinical Endoscopy.2024; 57(2): 253. CrossRef
Is Endoscopic Ultrasound-Guided Hepaticogastrostomy Safe and Effective after Failed Endoscopic Retrograde Cholangiopancreatography?—A Systematic Review and Meta-Analysis
Saqr Alsakarneh, Mahmoud Y. Madi, Dushyant Singh Dahiya, Fouad Jaber, Yassine Kilani, Mohamed Ahmed, Azizullah Beran, Mohamed Abdallah, Omar Al Ta’ani, Anika Mittal, Laith Numan, Hemant Goyal, Mohammad Bilal, Wissam Kiwan
Journal of Clinical Medicine.2024; 13(13): 3883. CrossRef
EUS-guided hepaticogastrostomy: practical tips and tricks
Kambiz Kadkhodayan, Shayan Irani
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A Possible Contraindication for Endoscopic Ultrasound-Guided Hepaticogastrostomy: A Giant Hiatal Hernia
Koichiro Mandai, Shiho Nakamura
Cureus.2024;[Epub] CrossRef
Endoscopic ultrasound-guided intervention for inaccessible papilla in advanced malignant hilar biliary obstruction
Partha Pal, Sundeep Lakhtakia
Clinical Endoscopy.2023; 56(2): 143. CrossRef
Liver impaction technique improves technical success rate of guidewire insertion during EUS-guided hepaticogastrostomy (with video)
Junichi Nakamura, Takeshi Ogura, Saori Ueno, Atsushi Okuda, Nobu Nishioka, Yuki Uba, Mitsuki Tomita, Kimi Bessho, Nobuhiro Hattori, Hiroki Nishikawa
Therapeutic Advances in Gastroenterology.2023;[Epub] CrossRef
Therapeutic endoscopic ultrasound: European Society of Gastrointestinal Endoscopy (ESGE) Technical Review
Roy L. J. van Wanrooij, Michiel Bronswijk, Rastislav Kunda, Simon M. Everett, Sundeep Lakhtakia, Mihai Rimbas, Tomas Hucl, Abdenor Badaoui, Ryan Law, Paolo Giorgio Arcidiacono, Alberto Larghi, Marc Giovannini, Mouen A. Khashab, Kenneth F. Binmoeller, Marc
Endoscopy.2022; 54(03): 310. CrossRef
Practical Tips for Safe and Successful Endoscopic Ultrasound-Guided Hepaticogastrostomy: A State-of-the-Art Technical Review
Saburo Matsubara, Keito Nakagawa, Kentaro Suda, Takeshi Otsuka, Masashi Oka, Sumiko Nagoshi
Journal of Clinical Medicine.2022; 11(6): 1591. CrossRef
Prevention of Serious Complications during Endoscopic Ultrasound-Guided Biliary Drainage: A Case-Based Technical Review
Surinder Singh Rana, Jimil Shah, Harish Bhujade, Ujjwal Gorsi, Mandeep Kang, Rajesh Gupta
Journal of Digestive Endoscopy.2022; 13(02): 082. CrossRef

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The Usefulness of 64-Multidetector CT Cholangiography for Diagnosis of Distal Common Bile Duct Obstruction: Comparison with Endoscopic Retrograde Cholangiopancreatography: Jae-Hyun Choi, M.D., Mee Yeon Lee, M.D., Won Joong Jeon, M.D., Hee Bok Chae, M.D., Seon Mee Park, M.D., Sei Jin Youn, M.D., Jae-Woon Choi, M.D.* and Il Heon Bae, M.D.^†; Korean J Gastrointest Endosc 2009;39(1):14-21. Published online July 30, 2009

Abstract PDF: Background
/Aims: The aim of this study was to evaluate the diagnostic accuracy of 64-multidetector CT (MDCT) cholangiography for determining the causes of distal common bile duct (CBD) obstruction.
Methods
Two hundred fifty consecutive patients underwent 64-MDCT for diagnosing the clinical and biochemical signs of bile duct obstruction. The causes of bile duct obstruction were assessed by the pre- and post-enhanced axial and coronal multiplanar reformation images of 64-MDCT. The results were compared with ERCP, biopsy and surgery.
Results
The sensitivity and specificity of MDCT for CBD stones were 96.1% and 84.9%, respectively. In seven patients, The CBD stones in 7 patients could not be detected on MDCT. Eleven patients with stones in the distal CBD, as detected on MDCT, had no stones seen on ERCP. For malignant obstruction, the sensitivity and specificity of MDCT were 97.0% and 98.6%, respectively. Three patients who were diagnosed with periampullary cancers on MDCT were disclosed to have severe papillitis on ERCP. One patient who was diagnosed with CBD stone by MDCT was disclosed to have ampullary cancer. The overall accuracy of MDCT for determining the causes of biliary obstruction was 90.5%.
Conclusions
MDCT cholangiography is a non-invasive method with relatively high sensitivity and high specificity for diagnosing the causes of distal CBD obstruction. (Korean J Gastrointest Endosc 2009;39:14-21)

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A Case of Clonorchiasis Presenting as Common Hepatic Duct Mass: Choul Woong Hwang, M.D., Byung Wook Lim, M.D., Ung Ryu, M.D., Jong Hoon Kim, M.D., Hye Yeon Park, M.D., Kyung Il Park, M.D., Sung Moon Jung, M.D., Kyung-Ah Kim, M.D., Jeon Ho Yang, M.D., June Sung Lee, M.D., Young Soo Moon, M.D., Young Bin Jeon, M.D.*, Sa; Korean J Gastrointest Endosc 2005;31(4):268-272. Published online October 30, 2005

Abstract PDF: The liver fluke, Clonorchis sinensis is an important human parasite and is endemic in Eastern Asia including Korea, China, and Japan. Patients acquire the infestation by eating raw or undercooked freshwater fish. Radiologic examinations usually reveal dilated peripheral intrahepatic bile ducts and normal extrahepatic bile duct. The diagnosis of clonorchiasis may sometimes be difficult and a presentation as an obstructive mass at the common hepatic duct is a rare event. Here we report a case of clonorchiasis of 54-year- old woman presented with epigastric pain. Endoscopic retrograde cholangiography revealed a mass at the common hepatic duct with dilatation of the intrahepatic ducts mimicking cholangiocarcinoma. Using an endoscopic basket, muddy, sludge-like materials were extracted through the papillary orifice. We report this case with a review of literatures. (Korean J Gastrointest Endosc 2005;31:268⁣272)

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악성 담도 협착 환자에서 새로이 개발된 PTFE 막부착형 금속성 인공도관의 유용성: Korean J Gastrointest Endosc 2003;27(5):423-423. Published online November 20, 2003

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담도 폐쇄를 일으킨 고립성 장기결핵 1 예 - 결핵성 담도 주위 림프절염 1 예 - ( A Case of Isolated-organ Tuberculosis Causing Common Bile Duct Obstruction ―Tuberculous periductal lymphadenitis ― ): Korean J Gastrointest Endosc 1999;19(1):143-147. Published online November 30, 1998

Abstract PDF: The explanation of isolated-organ tuberculosis rests on the assumption that in the course of the lymphatic or hematogenous dissemination of bacilli, organisms may be rapidly destroyed in all other sites save for the particular tissue involved in the isolated tuberculous process. Tuberculosis can arise in all tissues having lymphatics or blood supply, but the disease causing biliary tract obstruction has been known to be rare. Recently, we experi-enced a case of isolated-organ tuberculosis causing common bile duct obstruction and periductal lymph node enlargement in a 46-year-old Korean male. An ultrasonography-guided percutaneous needle biopsy revealed a granulomatous inflammation of the lymph node. After 7 months of anti-tuberculous medication, the common bile duct obstruction and periductal lymph node enlargement disappeared completely in a follow up abdominal CT and ERCP. (Korean J Gastrointest Endosc 19: 143 ∼147, 1999)

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