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DOI: 10.1055/s-2003-44596
Hepaticogastrostomy by Echo-Endoscopy as a Palliative Treatment in a Patient with Metastatic Biliary Obstruction
Publikationsverlauf
Submitted 10 January 2003
Accepted after Revision 19 May 2003
Publikationsdatum:
27. November 2003 (online)
![](https://www.thieme-connect.de/media/endoscopy/200312/lookinside/thumbnails/10.1055-s-2003-44596-1.jpg)
A palliative hepaticogastrostomy was performed under endoscopic ultrasound guidance in a patient with inoperable hepatic hilar obstruction, creating an anastomosis between the dilated left hepatic duct and the stomach, to relieve symptoms of cholangitis and to allow biliary drainage. This therapeutic procedure was used as an alternative method of drainage of the biliary tree because endoscopic retrograde cholangiopancreatography was not possible and because the percutaneous metallic stent which had been inserted earlier had become occluded (probably by tumor overgrowth). It was a two-step procedure. In the first step a hepatic duct was punctured through the gastric wall with placement of a plastic stent, which created a fistula between them. In a second step a covered, metallic, self-expandable stent was substituted for the plastic stent to maintain the anastomosis and to improve patency over the medium term. The patient's fever was relieved and the bilirubin level fell; the patient remained asymptomatic at the five-months-follow-up.
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M. Giovannini, M. D.
Oncology Unit 1 and Endoscopic Department · Paoli-Calmettes Institue ·
232 Bd de Sainte Marguerite BP 156 · 13273 Marseille Cedex 9 · France
Fax: + 33-4-91-22-3658 ·
eMail: hdjchir@marseille.fnclcc.fr