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CC BY 4.0 · Endoscopy 2025; 57(S 01): E232-E233
DOI: 10.1055/a-2548-6760
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Endoscopic ultrasound-guided hepaticojejunostomy through an endoscopic ultrasound-guided enteroanastomosis

Luis Araya-Acero 
1   Department of Gastroenterology, University of Costa Rica, San José, Costa Rica (Ringgold ID: RIN27915)
,
Maria Lynch-Mejia
1   Department of Gastroenterology, University of Costa Rica, San José, Costa Rica (Ringgold ID: RIN27915)
,
Fernanda Castro-Gonzalez
1   Department of Gastroenterology, University of Costa Rica, San José, Costa Rica (Ringgold ID: RIN27915)
,
Jorge Vargas-Madrigal 
1   Department of Gastroenterology, University of Costa Rica, San José, Costa Rica (Ringgold ID: RIN27915)
2   Department of Gastroenterology, Caja Costarricense de Seguro Social, San José, Costa Rica (Ringgold ID: RIN42697)
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Endoscopic retrograde cholangiopancreatography (ERCP) in surgically altered anatomy is a challenging procedure [1]. Transjejunal ERCP through endoscopic ultrasound (EUS)-guided enteroanastomosis appears to be a safe and effective technique [2]. We report a 65-year-old woman with a previous Roux-en-Y hepaticojejunal anastomosis presenting with acute bacterial cholangitis complicated by septic shock. She underwent unsuccessful enteroscopy-assisted ERCP. Given her altered anatomy, an EUS-guided approach was offered ([Video 1]).


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Endoscopic ultrasound-guided hepaticojejunostomy through an endoscopic ultrasound-guided enteroanastomosis.Video 1

A forward-viewing scope was advanced to the afferent limb, and a nasobiliary drainage (G21583; Cook Medical, Bloomington, Indiana, USA) was placed with connection to a water pump. A linear echoendoscope (GF-UCT 180; Olympus, Tokyo, Japan) connected to an ultrasound processor (Arietta 850; Fujifilm, Tokyo, Japan) was used, and by pumping water into the afferent limb this provided a clear view for creating a duodenojejunostomy with a 15-mm lumen-apposing metal stent (LAMS) (Axios; Boston Scientific, Marlborough, Massachusetts, USA) to access the biliary tree ([Fig. 1]). After allowing time for tract maturation, the duodenojejunostomy was accessed with a duodenoscope, but cannulation was not possible due to a very tight angulated stricture. A decision was made to access the LAMS with a forward-viewing echoendoscope (TGF-UC180J; Olympus) to create a new biliary anastomosis. The common hepatic duct was identified and punctured with a 19G needle ([Fig. 2]) (EZ Shot 3 Plus; Olympus). Confirming adequate location with a cholangiogram ([Fig. 3]), a 0.025-inch guidewire (VisiGlide; Olympus) was advanced. A cystotome (G30550; Cook Medical) was fed in, and a new hepaticojejunostomy was created and dilated up to 12 mm with a pneumatic balloon ([Fig. 4]) (CRE Rx; Boston Scientific). To finalize, 3 biodegradable 10 Fr stents (Archimedes; Q3 Medical Group, Dublin, Ireland) were placed. After successful drainage the patient improved, and no complications related to the procedure were documented.

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Fig. 1 Ultrasound image showing placement of lumen-apposing stent to access the biliary tree in a 65-year-old woman with acute bacterial cholangitis and altered anatomy after previous Roux-en-Y hepaticojejunal anastomosis.
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Fig. 2 Ultrasound image showing common hepatic duct punctured by a 19G fine-needle aspiration needle.
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Fig. 3 Endoscopic ultrasound (EUS)-guided cholangiogram showing successful puncture of the common hepatic duct.
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Fig. 4 Cholangiogram showing balloon dilation of the newly created EUS-guided hepaticojejunostomy.

EUS-guided enterostomy with hepaticojejunostomy drainage offers a novel alternative for bile duct access in patients with altered anatomy.

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Artikel online veröffentlicht:
12. März 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).

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  • References

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