Endoscopic Ultrasound Guided Hepatico – Gastrostomy

Background

A 50 year old man presented with jaundice a year after undergoing Whipple’s surgery for pancreatic head malignancy. There was a recurrent lesion causing Hepatico-jejunostomy site narrowing.

Diagnosis And Treatment

EUS guided puncture of IHBRD in the second segment of liver was done from stomach and after the cholangiogram, the tract was dilated sequentially using cystotomes till 10F and a 60×10 mm fully covered biliary metal stent was deployed connecting the stomach and the second segment of liver. A 7F 7cm double pigtail plastic stent was deployed within the metal stent to prevent its displacement. There were no periprocedural complications and the patient underwent chemotherapy after normalization of bilirubin. During follow-up 3 months after the procedure, the patient’s LFT remained normal.

Dilatation of tract withcystotomes