Malignant biliary obstruction treated with preoperative endoscopic ultrasound-guided hepaticogastrostomy: A case report

• DOI: 10.18528/ijgii240048
• Publication Date: 2025-01-22T15:03:17Z
• Authors: Taira Kuroda; Hideki Miyata; Yuka Kimura; Ayaka Nakamura; Takuya Matsuda; Kana Matsuoka; Mai Fukumoto; Kazuya Murakawa; Taisei Murakami; Hirofumi Izumoto; Kei Onishi; Shogo Kitahata; Kozue Kanemitsu-O...; Tomoe Kawamura; Fujimasa Tada; Eiji Tsubouchi; Jun Hanaoka; Atsushi Hiraoka; Tomoyuki Ninomiya
• Keywords: RC581-951; R; Medicine; Specialties of internal medicine; Neoplasms. Tumors. Oncology. Including cancer and carcinogens; preoperative procedures; endoscopic ultrasound-guided fine needle aspiration; gastric fistula; Internal medicine; RC31-1245; jaundice, obstructive; RC254-282

We present the case of a 76-year-old man who underwent preoperative endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) for obstructive jaundice caused by pancreatic head cancer. The patient had obstructive jaundice and cholangitis during neoadjuvant chemotherapy. Transpapillary biliary drainage using endoscopic retrograde cholangiopancreatography was attempted; however, it was unsuccessful because of duodenal tumor invasion. Therefore, EUS-HGS was performed. Jaundice and cholangitis improved promptly after EUS-HGS, and stent obstruction and migration were not observed before surgery. The stent was safely removed during surgery, and no postoperative complications occurred. Most studies of EUS-HGS for preoperative biliary drainage have been small and retrospective, and few have examined the safety of intraoperative stent removal. The fistula in our patient was promptly identified and the stent was safely removed despite the relatively limited field of view during robot-assisted laparoscopy. The promising findings of our case report can be used to inform EUS-based surgical strategies for biliary drainage with obstructive jaundice.