EUS-Guided Hepaticojejunostomy Using Novel Plastic Stent Combined with Antegrade Metal Stent Placement.

BACKGROUND: Endoscopic ultrasound-guided hepaticojejunostomy (EUS-HJS) combined with antegrade stenting (AS) can proceed if patients are complicated with duodenal obstruction or surgical anatomy such as Roux-en-Y esophagojejunostomy. A novel plastic stent (Gadelius Medical Co. Ltd., Tokyo, Japan) that is designed to prevent stent migration into the abdominal cavity was made available in Japan. Here, we describe technical tips for EUS-HJS combined with EUS-AS using this plastic stent.

TECHNICAL PRESENTATION: After the intrahepatic bile duct is punctured, the guidewire is inserted into the intestine across the bile duct obstruction site. Next, the fistula is dilated using a balloon catheter. And then, metal stent placement is antegradely performed. Finally, stent placement using this novel plastic stent is performed from the intrahepatic bile duct to the intestine.

CONCLUSION: Compared with EUS-HJS using a metal stent, EUS-HJS using this novel plastic stent has several advantages such as cost benefit, easy re-intervention, and preventing vomiting due to reflux bile juice. Therefore, EUS-HJS combined with AS using this novel plastic stent may be preferable compared with using a metal stent.