[Ecoendoscopy guided hepaticogastrostomy for management of hepatolithiasis and anastomotic stricture after Roux en Y hepaticojejunostomy].

Abstract

Endoscopic ultrasound-guided anterograde cholangiopancreatography (EUS-guided APC) allow us to address pathologies of the bile duct that are not treatable by endoscopic retrograde cholangiography (ERCP), such as: post-surgical benign strictures in altered anatomy, hepatolithiasis, gastric outlet obstruction, among others. Previously, when ERCP was not effective, surgical interventions such as Hepaticojejunostomy (HJ) or percutaneous transperietohepatic drainage (PTHD) were resorted to. However, EUS-guided APC has been shown to have greater clinical success, be less invasive and have a lower incidence of complications. We present the case of a 61-years-old patient with a history of HJ bypass surgery who presented abdominal pain due to hepatholitiasis and post-anastomosis benign biliary stricture, in whom the antegrade technique was performed by endoscopic ultrasound through the proximal stomach, called hepaticogastrostomy (HG) with good results.