Clin Endosc.  2024 Jul;57(4):542-546. 10.5946/ce.2022.209.

Endoscopic ultrasound-guided hepaticogastrostomy by puncturing both B2 and B3: a single center experience

• Elshair M
• Hara K
• Okuno N
• Haba S
• Kuwahara T
• Bakr A
• Elshafei A
• Abu-Amer MZ

• KMID: 2558112
• DOI: http://doi.org/10.5946/ce.2022.209

Abstract

Endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) through ducts B2 or B3 is effective in most patients with biliary obstruction, because B2 and B3 commonly join together. However, in some patients, B2 and B3 do not join each other due to invasive hilar tumors; therefore, single-route drainage is insufficient. Here, we investigated the feasibility and efficacy of EUS-HGS through both B2 and B3 simultaneously in seven patients. We decided to perform EUS-HGS through both B2 and B3 to achieve adequate biliary drainage because these two ducts were separate from each other. Here, we report a 100% technical and overall clinical success rate. Early adverse effects were closely monitored. Minimal bleeding was reported in one patient (1/7) and mild peritonitis in one patient (1/7). None of the patients experienced stent dysfunction, fever, or bile leakage after the procedure. EUS-HGS through both B2 and B3 simultaneously is safe, feasible, and effective for biliary drainage in patients with separated ducts.

Keyword

B2, 3; Endoscopic ultrasound; Endoscopic ultrasound-guided hepaticogastrostomy through both B2 and B3; Hepaticogastrostomy

Figure

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  Fig. 1. (A) Endoscopic ultrasound (EUS) picture showing puncture of B2 using forward-viewing EUS. (B) EUS picture showing puncture of B3 using oblique-view EUS. (C) Endoscopic picture showing that two fully covered self-expanded metallic stent (FCSEMS) open in the stomach. (D) Fluoroscopic image showing two FCSEMS deployed in B2 and B3 that open in the stomach. (E) Endoscopic picture showing two plastic stents open in the stomach.

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