ASGE Endoscopy Live: Interventional EUS and Endo-Hepatology | July 2023-7-13-23 Endoscopy Live Case Demonstration 3

7-13-23 Endoscopy Live Case Demonstration 3 - Orlando Health

Video Transcription

Video Summary

In this video, Dr. Shyam Varadarajulu demonstrates a QUS guided biliary drainage procedure. The patient is a 56-year-old with malignant obstructive jaundice and a 12-centimeter hepatic mass. The patient had previously undergone an ERCP with a stent placement, but further drainage is needed. Dr. Varadarajulu uses an EUS-guided hepatogastrostomy approach. He shows the EUS view and explains the difficulty in navigating the wire due to the size and location of the mass. He attempts the transgastric approach, but encounters resistance in navigating the wire. He decides to retract the scope and reposition for a different approach. He punctures the left radical and injects diluted contrast to confirm the position. He then uses a sixth French systotome and dilates the transgastric intrahepatic tract. He deploys a partially covered metal stent. The stent is positioned in the body of the stomach, allowing for drainage. Dr. Varadarajulu discusses the limitations of using plastic stents in this case.

Asset Subtitle

EUS-guided gallbladder drainage
Shyam Varadarajulu, MD

Keywords

QUS guided biliary drainage

malignant obstructive jaundice

hepatic mass

EUS-guided hepatogastrostomy

transgastric approach

metal stent