EUS-guided hepaticogastrostomy: practical tips and tricks

Abstract

Background and Aims: EUS-guided hepaticogastrostomy (EUS-HGS) has gained traction as a reliable and safe method for definitive biliary drainage in patients who cannot undergo traditional transampullary procedures. Many of the newly developed single-stage devices are not yet approved for clinical use in Western practice. Methods: We highlight key clinical and technical aspects of EUS-HGS using devices that are currently available in Western countries. The article is a comprehensive step-by-step technical review of EUS-HGS, and the video demonstrates high-level tips to overcome commonly encountered procedural challenges. Results: Patients with biliary obstruction underwent EUS-HGS at our center. The technical difficulties that were encountered are highlighted in the article and the accompanying video. The article and video provide a detailed review of (1) preprocedural considerations, (2) puncture site selection, (3) biliary puncture, (4) contrast injection, (5) guidewire manipulation, (6) tract dilation, and (7) stent placement. Conclusion: An understanding and implementation of the technical nuances highlighted in this article should help Western endoscopists navigate the complexities of EUS-HGS and ensure optimal outcomes.