EUS-RESCUING INTERNALLY PLACED SEMS DURING ENDOSCOPIC ULTRASOUND ASSISTED HEPATICOGASTROSTOMY

RESCUING INTERNALLY PLACED SEMS DURING ENDOSCOPIC ULTRASOUND ASSISTED HEPATICOGASTROSTOMY

Video Transcription

Video Summary

This video summarizes a case study conducted by Sandeep Laktakia and his team on rescuing internally placed self-expandable metal stents (SEMS) during endoscopic ultrasound-assisted hepatico-gastrostomy. The patient, a 60-year-old male with thylark-cholangiocarcinoma, had undergone ERCP with an uncovered biliary SEMS three months prior but developed cholangitis. ERCP failed to drain the left hepatic duct system, so U.S.-guided hepatico-gastrostomy was planned. The procedure involved puncturing the segment 3 duct, injecting contrast, and dilating the tract. While deploying a partially covered metal stent, it was found that its external end was outside the gastric valve but the internal end was in the left hepatic duct. By keeping the guide wire in place, a second fully covered SEMS was telescoped over it and deployed inside the gastric lumen, salvaging the adverse event. The video highlights the clinical implications of EUS-HGS as a fallback option for biliary drainage and emphasizes the importance of keeping the guide wire in place to prevent adverse events.

Asset Subtitle

Honorable Mention

Keywords

case study

self-expandable metal stents

endoscopic ultrasound-assisted hepatico-gastrostomy

cholangiocarcinoma

biliary drainage