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| Ahead of print publication |
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EUS-guided hepaticoduodenostomy for the management of postsurgical bile duct injury: An alternative to surgery (with video)
Carlos Robles-Medranda, Roberto Oleas, Martha Arevalo-Mora, Juan Alcivar-Vasquez, Raquel Del Valle
Endoscopy Division, Instituto Ecuatoriano de Enfermedades Digestivas, Guayaquil, Ecuador
| Date of Submission | 03-May-2021 |
| Date of Acceptance | 30-Nov-2021 |
| Date of Web Publication | 21-Mar-2022 |
Correspondence Address:
Carlos Robles-Medranda,
Endoscopy Division, Instituto Ecuatoriano de Enfermedades Digestivas, Av. Abel Romero Castillo y Av. Juan Tanca Marengo SN, Torre Vitalis II, Office 405-406, Guayaquil 090505
Ecuador
 Source of Support: None, Conflict of Interest: None DOI: 10.4103/EUS-D-21-00115 PMID: 35313418
How to cite this URL:
Robles-Medranda C, Oleas R, Arevalo-Mora M, Alcivar-Vasquez J, Del Valle R. EUS-guided hepaticoduodenostomy for the management of postsurgical bile duct injury: An alternative to surgery (with video). Endosc Ultrasound [Epub ahead of print] [cited 2022 Sep 24]. Available from: http://www.eusjournal.com/preprintarticle.asp?id=340249 |
A 24-year-old female with a surgical history of laparoscopic cholecystectomy converted into an open cholecystectomy, secondary to acute calculous cholecystitis, presented with jaundice, fever (101.5°F), right upper quadrant abdominal pain, and nausea 72-h postprocedure. She had a total bilirubin level of 23 mg/dL, a direct bilirubin level of 17.51 mg/dL, and an alkaline phosphatase of 1312 U/L. Endoscopic retrograde cholangiopancreatography [Figure 1] performed 3 days after surgery showed a complete bile duct dissection located 18 mm from the biliary confluence on both sides without anastomosis (Strasberg type E2). No surgical biliodigestive anastomosis was done intraoperatively in this patient who presented with a complete suture of the divorced common bile duct. | Figure 1: Endoscopic retrograde cholangiopancreatography showing a complete common bile duct defect 18 mm from the biliary confluence (Strasberg type E2)
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EUS-guided hepaticoduodenostomy was proposed using a 4.0-mm working channel linear array therapeutic echoendoscope (EG38-J10UT; Pentax Medical, Hamburg, Germany). We used a 10 mm × 10 mm lumen-apposing metal stent (LAMS) with an electrocautery-enhanced delivery system (Hot Axios™, Boston Scientific, MA, USA), and a 10 Fr × 10 cm double-pigtail plastic stent was deployed through the LAMS [Figure 3]. The procedure was successfully performed under endosonographic and fluoroscopic guidance [Figure 2]. The patient complained of postprocedure abdominal pain and fever. She was admitted for intravenous hydration, antibiotic therapy (ceftriaxone and metronidazole), and antipyretics. Her medical condition improved with conservative management, being discharged 48 h later. Computed tomographic scan confirmed the correct position of the LAMS and no leaks were observed [Figure 4]. At the 3-week follow-up, her total and direct bilirubin levels were 3 mg/dL and 1.5 mg/dL, respectively; and, after 12 weeks, the patient remained stable [Video 1 [Additional file 1]]. | Figure 2: Fluoroscopy view of the cholangiogram showing the deployment of the lumen-apposing metal stent between the hilum and duodenum
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 | Figure 3: EUS-guided hepaticoduodenostomy for the management of postsurgical bile duct injury as a novel alternative to surgical intervention
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 | Figure 4: Computed tomography scan on coronal plane showing the correct positioning of the lumen-apposing metal stent of the hepaticoduodenostomy
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Bile duct injury is a severe complication of laparoscopic cholecystectomy. Surgical hepaticoduodenostomy is the standard proposed intervention; however, short- and long-term complications such as anastomotic leaks, strictures, recurrent cholangitis, and secondary biliary cirrhosis may ensue, impairing morbidity and quality of life.[1],[2] The role of EUS-guided bilioenteric anastomosis in benign etiologies has been described in limited cases,[3] with most data coming from malignant etiologies. EUS-guided hepaticoduodenostomy may be a novel alternative for the management of postsurgical bile duct injury when feasible. This procedure was feasible, safe, and effective in this patient who had a complete dissection and suture of the common bile duct; however, large case series and prospective cohorts are required.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given her consent for her images and other clinical information to be reported in the journal. The patient understands that her name and initials will not be published and due efforts will be made to conceal her identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Nil.
Conflicts of interest
Carlos Robles-Medranda is a key opinion leader and consultant for Pentax Medical, Boston Scientific, Steris, Medtronic, Motus, Micro-tech, G-Tech Medical Supply, CREO Medical, EndoSound, and Mdconsgroup. He is also an Editorial Board Member of the journal. This article was subject to the journal's standard procedures, with peer review handled independently of this editor and his research groups. The other authors declare no conflicts of interest.
| References | |  |
| 1. | Schreuder AM, Busch OR, Besselink MG, et al. Long-term impact of iatrogenic bile duct injury. Dig Surg 2020;37:10-21.  |
| 2. | Pesce A, Palmucci S, La Greca G, et al. Iatrogenic bile duct injury: impact and management challenges. Clin Exp Gastroenterol 2019;12:121-8. |
| 3. | Nakai Y, Kogure H, Isayama H, et al. Endoscopic Ultrasound-guided biliary drainage for benign biliary diseases. Clin Endosc 2019;52:212-9. |
[Figure 1], [Figure 2], [Figure 3], [Figure 4]
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