Rescue technique for bleeding after placement of plastic stent in EUS–guided hepaticogastrostomy (with videos)
Year: 2023
Type: article
Study design: Case Report
Abstract: Although the technique of EUS-guided hepaticogastrostomy (EUS-HGS) has been established, various complications have also been reported; there have been a few reports about bleeding during the procedures of EUS-HGS.[1–4] We report a rare case of bleeding, which occurred immediately after the placement of a plastic stent and the rescue technique we used to arrest the bleeding. An 87-year-old woman with choledochojejunal anastomotic stenosis after liver transplantation was admitted to our hospital with obstructive jaundice [Figure 1A]. She received antithrombotic therapy for atrial fibrillation. We performed EUS-HGS after the cessation of the antithrombotic therapy (non–vitamin K antagonist oral anticoagulant). During the procedure, we punctured the bile duct using a 22-gauge fine needle, avoiding the blood vessels. Tract dilation was performed using a tapered balloon catheter (4-mm diameter, REN; Kaneka, Osaka, Japan). After the placement of 2 guidewires, a plastic stent was successfully placed through the first guidewire (Figure 1B and Video 1). However, active bleeding was detected on the endoscopic image [Figure 2A]. At first, we tried achieving hemostasis by injection of ice water. Subsequently, the puncture site was compressed by a balloon equipped with the echoendoscope. Then, we inflated a 4-mm tapered balloon catheter at the puncture site for hemostasis. However, the active bleeding continued. Therefore, we changed the scope from an oblique-viewing echoendoscope to a lateral-viewing duodenoscope (JF-260 V; Olympus, Tokyo, Japan) along the second guidewire. A balloon catheter (10-mm diameter; Stone Extraction Balloon, Micro-Tech, Nanjing, China) was inserted along with the second guidewire; it was inflated and pressed twice against the fistula entrance [Figure 2B].Figure 1: A, Abdominal computed tomography showing the dilation of the intrahepatic bile duct. B, Successful placement of a plastic stent on the fluoroscopic image. {"href":"Single Video Player","role":"media-player-id","content-type":"play-in-place","position":"float","orientation":"portrait","label":"Video","caption":"Videos are only available at the official website of the journal (http://www.eusjournal.com).","object-id":[{"pub-id-type":"doi","id":""},{"pub-id-type":"other","content-type":"media-stream-id","id":"1_o1ff0l09"},{"pub-id-type":"other","content-type":"media-source","id":"Kaltura"}]} Figure 2: Endoscopic findings. A, Active bleeding after the placement of a plastic stent in the EUS-guided hepaticogastrostomy. B, Balloon compression as a treatment for bleeding.Hemostasis was achieved through these procedures (Video 2). She was discharged on postoperative day 12 without any complications or exacerbation of anemia. {"href":"Single Video Player","role":"media-player-id","content-type":"play-in-place","position":"float","orientation":"portrait","label":"Video","caption":"Videos are only available at the official website of the journal (http://www.eusjournal.com).","object-id":[{"pub-id-type":"doi","id":""},{"pub-id-type":"other","content-type":"media-stream-id","id":"1_jsxjqvi4"},{"pub-id-type":"other","content-type":"media-source","id":"Kaltura"}]} Balloon compression using a stone extraction catheter may be useful for bleeding after EUS-HGS.
Source: Endoscopic Ultrasound
Authors: Akihisa Ohno, Nao Fujimori, Noboru Harada
Institution: Kyushu University
Language: English
Subfield: Gastroenterology
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
OpenAlex ID: W4386593161