Unpredictable Event during EUS-Guided Hepaticojejunostomy

Abstract

Endoscopic ultrasound (EUS)-guided biliary drainage is a therapeutic alternative method in patients with cholestasis where the ampulla of Vater cannot be reached because several reasons. An unfortunate complication during EUS-guided biliary drainage was presented in this report. A 53-year-old male patient presented with jaundice and pruritus. He had a history of total gastrectomy due to gastric cancer. An abdominal tomography scan detected a tumoral mass in the common bile duct due to the recurrence of gastric cancer. We decided to perform EUS-guided hepaticojejunostomy because biliary drainage cannot be obtained by conventional methods and percutaneous drainage impairs patient comfort. A double pigtail plastic stent was placed from the jejunum into the segment-3 bile duct towards the hilus. After that echoduodenoscope was removed to the outside gently. We noticed that the stent was stuck in the echoduedonoscope elevator. We reached into the bile duct again and placed a double-pigtail plastic stent successfully.

Keywords

• Cholestasis
• Extrahepatik Cholestasis
• Endoscopic Ultrasound (EUS)

EUS Kılavuzluğundaki Hepatikojejunostomi Sırasında Öngörülemeyen Olay

Abstract

Kolestazı olan hastalarda ampulla Vateri’ye çeşitli nedenlerde erişilemediği durumlarda endoskopik ultrason (EUS) kılavuzluğunda biliyer drenaj alternatif bir terapötik yöntemdir. Bu raporda, EUS kılavuzluğunda biliyer drenaj sırasında talihsiz bir komplikasyonun bildirilmektedir. 53 yaşında erkek hasta sarılık ve kaşıntı şikayeti ile başvurdu. Mide kanseri nedeniyle total gastrektomi öyküsü mevcuttu. Abdomen tomografisinde mide kanseri nüksüne bağlı gelişen peritoneal karsinamoza bağlı koledokta tümöral kitle saptandı. Biliyer drenajın konvansiyonel yöntemlerle sağlanamaması ve perkütan drenajın hasta konforunu bozması nedeniyle EUS eşliğinde hepatikojejunostomi yapılmasına karar verildi. Jejunumdan segment-3 safra yoluna hilusa uzanacak şekilde double pigtail plastik stent yerleştirildi. Ardından ekoduedonoskop yavaşça dışarıya çıkarıldı. Stentin ekoduedonoskopun kaldıracına takıldığı fark edildi. Safra kanalına tekrar ulaşıldı ve bir double-pigtail plastik stent başarıyla yerleştirildi.

Keywords

• Kolestaz
• Ekstrahepatik Kolestaz
• Endoskopik Ultrason(EUS)

References

1. Dumonceau JM, Tringali A, Papanikolaou IS, Blero D, Mangiavillano B, Schmidt A, et al. Endoscopic biliary stenting: indications, choice of stents, and results: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline - Updated October 2017. Endoscopy. 2018;50(9):910-30.
2. Voegeli DR, Crummy AB, Weese JL. Percutaneous transhepatic cholangiography, drainage, and biopsy in patients with malignant biliary obstruction. An alternative to surgery. Am J Surg. 1985;150(2):243-7.
3. Nakai Y, Kogure H, Isayama H, Koike K. Endoscopic ultrasound-guided biliary drainage for unresectable hilar malignant biliary obstruction. Clin Endosc. 2019;52(3):220-5.
4. Artifon EL, Loureiro JF, Baron TH, Fernandes K, Kahaleh M, Marson FP. Surgery or EUS-guided choledochoduodenostomy for malignant distal biliary obstruction after ERCP failure. Endosc Ultrasound. 2015;4(3):235-43.
5. Räty S, Sand J, Piironen A, Nordback I. Complications of palliative hepaticojejunostomy and gastrojejunostomy in unresectable periampullary cancer: patient- and disease-related risk factors. Hepatogastroenterology. 2006;53(67):133-7.
6. Nennstiel S, Weber A, Frick G, Haller B, Meining A, Schmid RM, et al. Drainage-related complications in percutaneous transhepatic biliary drainage: an analysis over 10 years. J Clin Gastroenterol. 2015;49(9):764-70.
7. Burmester E, Niehaus J, Leineweber T, Huetteroth T. EUS-cholangio-drainage of the bile duct: report of 4 cases. Gastrointest Endosc. 2003;57(2):246-51.
8. James TW, Fan YC, Baron TH. EUS-guided hepaticoenterostomy as a portal to allow definitive antegrade treatment of benign biliary diseases in patients with surgically altered anatomy. Gastrointest Endosc. 2018;88(3):547-54.

9. van der Merwe SW, van Wanrooij RLJ, Bronswijk M, Everett S, Lakhtakia S, Rimbas M, et al. Therapeutic endoscopic ultrasound: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy. 2022;54(2):185-205.
10. Khashab MA, Valeshabad AK, Afghani E, Singh VK, Kumbhari V, Messallam A, et al. A comparative evaluation of EUS-guided biliary drainage and percutaneous drainage in patients with distal malignant biliary obstruction and failed ERCP. Dig Dis Sci. 2015;60(2):557-65.
11. Gupta K, Perez-Miranda M, Kahaleh M, Artifon EL, Itoi T, Freeman ML, et al. Endoscopic ultrasound-assisted bile duct access and drainage: multicenter, long-term analysis of approach, outcomes, and complications of a technique in evolution. J Clin Gastroenterol. 2014;48(1):80-7.