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Ogura et al. Mini-invasive Surg 2018;2:8 Mini-invasive Surgery
DOI: 10.20517/2574-1225.2017.48

Case Report Open Access

Successful treatment for infected biloma after
endoscopic ultrasound-guided hepaticogastrostomy
using double stent placement technique

Takeshi Ogura, Atsushi Okuda, Akira Miyano, Nobu Nishioka, Kazuhide Higuchi

Second Department of Internal Medicine, Osaka Medical College, Osaka 569-8686, Japan.

Correspondence to: Dr. Takeshi Ogura, Second Department of Internal Medicine, Osaka Medical College, 2-7 Daigakuchou,
Takatsukishi, Osaka 569-8686, Japan. E-mail: oguratakeshi0411@yahoo.co.jp
How to cite this article: Ogura T, Okuda A, Miyano A, Nishioka N, Higuchi K. Successful treatment for infected biloma after
endoscopic ultrasound-guided hepaticogastrostomy using double stent placement technique. Mini-invasive Surg 2018;2:8.
http://dx.doi.org/10.20517/2574-1225.2017.48

Received: 24 Nov 2017 First Decision: 6 Mar 2018 Revised: 8 Mar 2018 Accepted: 29 Mar 2018 Published: 23 Apr 2018
Science Editor: Charles F. Bellows Copy Editor: Jun-Yao Li Production Editor: Huan-Liang Wu

Abstract
This case report describes a treatment of an elderly man who had undergone pancreaticoduodenectomy (Whipple
Procedure) due to bile duct cancer. Herein, we describe technical tips of endoscopic ultrasound (EUS)-guided
hepaticojejunostomy EUS-HJS combined with EUS-guided antegrade stenting (EUS-AS) using novel plastic stent. First,
intrahepatic bile duct was punctured using 19G fine needle aspiration needle. Next, the 0.025-inch guidewire was
inserted into the biliary tract. After the guidewire was advanced into the intestine, the bile duct and the intestine wall
were dilated using by balloon catheter. The covered metal stent delivery system was antegradely inserted across the
stricture site, and stent placement was performed from the intestine to the bile duct. Finally, stent placement from the
intrahepatic bile duct to the intestine using novel plastic stent was successfully performed without any adverse events.

Keywords: Endoscopic ultrasound, endoscopic ultrasound-guided hepaticojejunostomy, liver abscess, endoscopic
ultrasound-guided biliary drainage

INTRODUCTION
Trans-jejunum biliary drainage with endoscopic ultrasound (EUS)-guided hepaticojejunostomy (EUS-HJS)
[1]
is now a well established procedure . However, EUS-guided biliary drainage (EUS-BD) procedures have
possibility of several adverse events such as stent migration or bile leakage. To prevent these adverse events,
a covered, self-expandable, metal stent (CSEMS) is usually selected and EUS-BD is sometimes combined
with EUS-guided antegrade stenting (AS). If CSEMS obstruction occurs, re-intervention is challenging in

© The Author(s) 2018. Open Access This article is licensed under a Creative Commons Attribution 4.0
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