Stent placement using dual ‐channel endoscope for biloma after EUS‐guided hepaticogastrostomy

AbstractEndoscopic ultrasound ‐guided hepaticogastrostomy (EUS‐HGS) is used for malignant biliary obstruction (MBO) when endoscopic retrograde cholangioscopy is technically challenging. Clinical practical guideline recommends self‐expandable metallic stents (SEMS) of>10 cm to prevent stent migration; however, additional endoscopic reintervention occasionally becomes difficult because of the length [1 ‐4]. Here, we present a case of biloma caused by stent migration after EUS‐HGS, and plastic stent placement was successfully performed using a dual‐channel endoscope. A 57‐year‐old man with unresectable pancreatic cancer underwent transpapillary biliary metallic stent (BMS) placement for M BO. Then, EUS‐HGS was performed using an end‐bare‐type fully covered SEMS (Niti‐S, 8 mm × 10 cm; Taewoong Medical, Seoul, Korea) for stent obstruction with duodenal invasion due to tumor. However, he developed a high fever 10 days after EUS‐HGS. Contrast‐enhanced computed tomography ind icated biloma formation caused by stent migrated in the liver parenchyma (Fig. 1). We could not remove the EUS‐HGS stent, therefore drainage from the stomach through the stent using a dual‐channel endoscope (GIF‐2TQ260M; Olympus, Tokyo, Japan) was performed. The edge of the stent was fixed by a snare from one channel, and a catheter with a hairpin‐curved guidewire was inserted through the fixed stent from the other channel (Fig. 2) [5]. The guidewire was easily passed thro...
Source: Journal of Hepato-Biliary-Pancreatic Surgery - Category: Surgery Authors: Tags: HOW I DO IT Source Type: research