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Efficacy and safety of EUS-guided hepaticoesophagostomy (EUS-HES) for malignant biliary obstruction: the first case series

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Abstract

Background

EUS-guided hepaticoesophagostomy (EUS-HES) was reported as an alternative procedure when puncture through the esophagus was inevitable. However, the existing data is very limited. We aimed to evaluate the efficacy and safety of EUS-HES in patients with difficult malignant biliary obstruction.

Methods

All cases who underwent EUS-HES at our institute were retrospectively reviewed.

Results

A total of 11 patients underwent EUS-HES from January 2011 to December 2017. Five were male, and the mean age was 57.9 ± 6.3 years. The majority of the patients (8 out of 11 patients) had a biliary obstruction caused by cholangiocarcinoma. The technical success was 100%. The mean procedure time was 73.2 ± 37.6 min. The main reason for EUS-HES was the improper alignment of the bile duct due to left lobe hypertrophy. The clinical success was 90.9%. The mean overall survival was 97.8 ± 68.5 days. No major procedure-related complication, particularly pneumomediastinum, occurred.

Conclusions

EUS-HES is a technically feasible and safe procedure to provide biliary drainage, especially in patients with left hepatic lobe hypertrophy. Using a bougie dilator instead of balloon dilation can avoid previously reported complications.

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Authors and Affiliations

  1. Siriraj GI Endoscopy Center, Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, 10700, Thailand

    Manus Rugivarodom & Varayu Prachayakul

  2. Liver and Digestive Institute, Samitivej Sukhumvit Hospital, Bangkok, 10110, Thailand

    Pitulak Aswakul

  3. Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, 10210, Thailand

    Karjpong Techathuvanan

  4. Division of Gastroenterology, Department of Internal Medicine, Hatyai Hospital, Songkhla, 90110, Thailand

    Arunchai Chang

Authors
  1. Manus Rugivarodom
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  2. Pitulak Aswakul
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  3. Karjpong Techathuvanan
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  4. Arunchai Chang
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  5. Varayu Prachayakul
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Corresponding author

Correspondence to Varayu Prachayakul.

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Disclosures

Dr. Manus Rugivarodom, Dr. Pitulak Aswakul, Dr. Karjpong Techathuvanan, Dr. Arunchai Chang, and Dr.Varayu Prachayakul have no conflicts of interest or financial ties to disclose.

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Rugivarodom, M., Aswakul, P., Techathuvanan, K. et al. Efficacy and safety of EUS-guided hepaticoesophagostomy (EUS-HES) for malignant biliary obstruction: the first case series. Surg Endosc 36, 1117–1122 (2022). https://doi.org/10.1007/s00464-021-08378-1

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  • DOI: https://doi.org/10.1007/s00464-021-08378-1

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