Question

EUS guided hepatico-gastrostomy.

Hint:

EUS-guided hepatico-gastrostomy is an effective option for patients with obstructive jaundice when other interventions are not possible. Careful patient selection and expertise are essential for success.

Answer 1

Endoscopic ultrasound (EUS)-guided hepatico-gastrostomy (HGS) is a minimally invasive procedure used to create a bypass between the hepatic duct and the stomach, typically in patients with obstructive jaundice and unsuitable for surgical bypass or percutaneous transhepatic cholangiography (PTC).
Step 1: Indications:
1. Obstructive Jaundice: EUS-guided HGS is used to relieve biliary obstruction caused by malignant or benign lesions, such as cholangiocarcinoma or pancreatic head tumors.
2. Failed PTC or Surgery: It is an alternative to surgical bypass or percutaneous drainage when conventional approaches fail or are not feasible.
Step 2: Procedure:
1. Accessing the Biliary System: EUS is used to locate the liver, bile ducts, and stomach, and a needle is advanced into the hepatic duct under real-time imaging guidance.
2. Stent Placement: A stent is placed between the hepatic duct and the stomach to allow bile drainage directly into the stomach, bypassing the obstruction.
Step 3: Benefits and Risks:
1. Benefits: The procedure is minimally invasive and provides rapid relief of jaundice, improving quality of life in patients with biliary obstruction.
2. Risks: Potential complications include infection, bleeding, stent migration, and perforation.