|IMAGES AND VIDEOS
|Ahead of print publication
Ingrown and exteriorized hilar tumor through hepaticogastrostomy stent causing upper gastrointestinal bleeding (with video)
Borathchakra Oung1, Thanawat Luangsukrerk2, Suppawatsa Plaidum2, Pradermchai Kongkam3
1 Department of Medicine, Division of Gastroenterology, Excellence Center for Gastrointestinal Endoscopy, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand; Department of Gastroenterology, Calmette Hospital, Phnom Penh, Cambodia
2 Department of Medicine, Division of Gastroenterology, Excellence Center for Gastrointestinal Endoscopy, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
3 Department of Medicine, Division of Gastroenterology, Excellence Center for Gastrointestinal Endoscopy, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Thai Red Cross Society; Excellence Center for Gastrointestinal Endoscopy, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, and Pancreas Research Unit, Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
|Date of Submission||31-Oct-2021|
|Date of Acceptance||15-Feb-2022|
|Date of Web Publication||20-Jul-2022|
1873, GI Endoscopy unit, 10th floor Bhumisirimunkalanusorn building, King Chulalongkorn Memorial Hospital, Rama IV road, Pathumwan, Bangkok 10330
Source of Support: None, Conflict of Interest: None
|How to cite this URL:|
Oung B, Luangsukrerk T, Plaidum S, Kongkam P. Ingrown and exteriorized hilar tumor through hepaticogastrostomy stent causing upper gastrointestinal bleeding (with video). Endosc Ultrasound [Epub ahead of print] [cited 2022 Dec 1]. Available from: http://www.eusjournal.com/preprintarticle.asp?id=351308
Interventional EUS has evolved rapidly in recent years, with a variety of therapeutic procedures, including EUS-guided biliary drainage (EUS-BD). With the development of new tools and techniques, this procedure has become more effective, safer, and simpler, which is recommended in case of failure of conventional procedures such as ERCP.,
A 69-year-old male diagnosed with unresectable malignant hilar biliary obstruction (MHBO) presented with recurrent biliary obstruction (RBO). Fourteen months ago, the patient had MHBO and was treated with bilateral self-expandable metal stents (SEMS) (side-by-side manner), and another 10 mm × 120 mm partially covered SEMS (GIOBOR; Taewoong-Medical Co, Seoul, South Korea) as a hepaticogastrostomy (HGS) stent drained from intrahepatic bile duct (IHD) segment 3. Subsequently, the patient had percutaneous biliary drainage drained from IHD segments 7 and 8 [Figure 1]a, [Figure 1]b, [Figure 1]c, [Figure 1]d. In this visit, the patient presented with melena and obstructive jaundice suspected for RBO. An emergency gastroscopy revealed tumor ingrown through intact HGS stent and exteriorized into the gastric lumen with blood clot, responsible for bleeding [Figure 2] and [Video 1 [Additional file 1]].
|Figure 1: Biliary drainage. (a) Cholangioscopy showed malignant hilar stricture; (b) Two uncovered self-expandable metal stents were placed side-by-side; (c) a 10 mm × 120 mm partially covered self-expandable metal stents (GIOBOR; Taewoong-Medical Co, Seoul, South Korea) as a hepaticogastrostomy stent drained from intrahepatic bile duct segment 2 and 3; (4) fluoroscopic view showed a combination of a self-expandable metal stent placed by EUS-hepaticogastrostomy procedure, two self-expandable metal stents placed by endoscopic retrograde cholangiopancreatography and a plastic tube placed by percutaneous biliary drainage procedure|
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EUS-HGS was known to have advantage over the ERCP drainage in terms of longer stent patency time by avoiding the risk of tumor ingrown with reported stent patency up to 402 days. To our best knowledge, this is the first case report of tumor gown within an HGS stent and went into the intragastric part of the stent, causing upper gastrointestinal bleeding after a period of 425 days from the index EUS-HGS. Hence, MHBO which is sufficiently drained by a combination of endoscopic and radiological approach, provide long survival to the patient, allowing tumor to grow inward through HGS stents.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given his consent for his images and other clinical information to be reported in the journal. The patient understands that his name and initials will not be published and due efforts will be made to conceal his identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
Pradermchai Kongkam is 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 her research group.
| References|| |
Khoo S, Do ND, Kongkam P. Efficacy and safety of EUS biliary drainage in malignant distal and Hilar biliary obstruction: A comprehensive review of literature and algorithm. Endosc Ultrasound
Giovannini M. EUS-guided hepaticogastrostomy. Endosc Ultrasound
Paik WH, Park DH. Outcomes and limitations: EUS-guided hepaticogastrostomy. Endosc Ultrasound
[Figure 1], [Figure 2]