Clinical Endoscopy

Original Articles

Safety of endoscopic ultrasound-guided hepaticogastrostomy in patients with malignant biliary obstruction and ascites: Tsukasa Yasuda, Kazuo Hara, Nobumasa Mizuno, Shin Haba, Takamichi Kuwahara, Nozomi Okuno, Yasuhiro Kuraishi, Takafumi Yanaidani, Sho Ishikawa, Masanori Yamada, Toshitaka Fukui; Clin Endosc 2024;57(2):246-252. Published online September 7, 2023; DOI: https://doi.org/10.5946/ce.2023.075

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Background
/Aims: Endoscopic ultrasound (EUS)-guided hepaticogastrostomy (EUS-HGS) is useful for patients with biliary cannulation failure or inaccessible papillae. However, it can lead to serious complications such as bile peritonitis in patients with ascites; therefore, development of a safe method to perform EUS-HGS is important. Herein, we evaluated the safety of EUS-HGS with continuous ascitic fluid drainage in patients with ascites.
Methods
Patients with moderate or severe ascites who underwent continuous ascites drainage, which was initiated before EUS-HGS and terminated after the procedure at our institution between April 2015 and December 2022, were included in the study. We evaluated the technical and clinical success rates, EUS-HGS-related complications, and feasibility of re-intervention.
Results
Ten patients underwent continuous ascites drainage, which was initiated before EUS-HGS and terminated after completion of the procedure. Median duration of ascites drainage before and after EUS-HGS was 2 and 4 days, respectively. Technical success with EUS-HGS was achieved in all 10 patients (100%). Clinical success with EUS-HGS was achieved in 9 of the 10 patients (90 %). No endoscopic complications such as bile peritonitis were observed.
Conclusions
In patients with ascites, continuous ascites drainage, which is initiated before EUS-HGS and terminated after completion of the procedure, may prevent complications and allow safe performance of EUS-HGS.

Citations

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Prevention of Adverse Events in Endoscopic Ultrasound‐Guided Biliary Drainage
Hirotoshi Ishiwatari, Hiroki Sakamoto, Takuya Doi, Masahiro Yamamura
DEN Open.2026;[Epub] CrossRef
Feasibility and safety of EUS-guided biliary drainage in inexperienced centers: a multicenter study in southwest Japan
Takehiko Koga, Yusuke Ishida, Shunpei Hashigo, Yuzo Shimokawa, Hirofumi Harima, Kazuhisa Okamoto, Akihisa Ohno, Tsukasa Miyagahara, Toshihiro Fujita, Satoshi Fukuchi, Kosuke Takahashi, Hiroki Taguchi, Norimasa Araki, Yuichiro Ohtsuka, Toshiyuki Uekitani,
Gastrointestinal Endoscopy.2025; 101(4): 843. CrossRef
Clinical effect of percutaneous hepatic puncture biliary drainage combined with metal stent implantation in the treatment of malignant obstructive jaundice
Shoulin Zhang, Shaopeng Huang, Zheng Xing, Youwen Song, Fujian Yuan
BMC Surgery.2025;[Epub] CrossRef
Efficacy and safety of endoscopic ultrasound-guided hepaticogastrostomy for biliary drainage in hypervascular hepatocellular carcinoma: a retrospective study from Japan
Kenneth Tachi, Kazuo Hara, Nozomi Okuno, Shin Haba, Takamichi Kuwahara, Toshitaka Fukui, Ahmed Mohammed Sadek, Hossam El-Din Shaaban Mahmoud Ibrahim, Minako Urata, Takashi Kondo, Yoshitaro Yamamoto
Clinical Endoscopy.2025; 58(3): 448. CrossRef
Management of iatrogenic perforations during endoscopic interventions in the hepato-pancreatico-biliary tract
Kirsten Boonstra, Rogier P. Voermans, Roy L.J. van Wanrooij
Best Practice & Research Clinical Gastroenterology.2024; 70: 101890. CrossRef
Is Endoscopic Ultrasound-Guided Hepaticogastrostomy Safe and Effective after Failed Endoscopic Retrograde Cholangiopancreatography?—A Systematic Review and Meta-Analysis
Saqr Alsakarneh, Mahmoud Y. Madi, Dushyant Singh Dahiya, Fouad Jaber, Yassine Kilani, Mohamed Ahmed, Azizullah Beran, Mohamed Abdallah, Omar Al Ta’ani, Anika Mittal, Laith Numan, Hemant Goyal, Mohammad Bilal, Wissam Kiwan
Journal of Clinical Medicine.2024; 13(13): 3883. CrossRef
Endoscopic ultrasound-guided antegrade stenting combined with closure of the puncture route using self-assembling peptide solution in a jaundiced patient with ascites
Hirotsugu Maruyama, Kojiro Tanoue, Tatsuya Kurokawa, Yoshinori Shimamoto, Yuki Ishikawa-Kakiya, Akira Higashimori, Yasuhiro Fujiwara
Endoscopy.2024; 56(S 01): E953. CrossRef
The Role of Therapeutic Endoscopic Ultrasound in Management of Malignant Double Obstruction (Biliary and Gastric Outlet): A Comprehensive Review with Clinical Scenarios
Giuseppe Dell’Anna, Rubino Nunziata, Claudia Delogu, Petra Porta, Maria Vittoria Grassini, Jahnvi Dhar, Rukaia Barà, Sarah Bencardino, Jacopo Fanizza, Francesco Vito Mandarino, Ernesto Fasulo, Alberto Barchi, Francesco Azzolini, Guglielmo Albertini Petron
Journal of Clinical Medicine.2024; 13(24): 7731. CrossRef

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Endoscopic Ultrasound-Guided Random Omental Fine Needle Aspiration: A Novel Technique for the Diagnosis of Peritoneal Carcinomatosis: Pradeep Kumar Siddappa, Neha Jain, Naveen K. Agarwal, Monika Jain, Gurwant Singh Lamba; Clin Endosc 2020;53(5):594-599. Published online September 29, 2020; DOI: https://doi.org/10.5946/ce.2019.175

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Background
/Aims: Diagnostic abdominal paracentesis has been described in literature to have variable sensitivity of 50%–75% for the detection of peritoneal carcinomatosis (PC). We believe that random needle aspirates from the omentum, even in the absence of obvious deposits by endoscopic ultrasound (EUS), could prove malignancy in patients with PC.
Methods
Consecutive patients who underwent EUS for diagnosis and staging of cancer and found to have ascites were included after obtaining informed consent. EUS-guided fine needle aspiration (EUS-FNA) from random sites in the omentum was performed through the transgastric route using a linear echoendoscope.
Results
Fifty-four patients underwent EUS during October 2015 to April 2017 for detection, staging, or FNA of a suspected malignant lesion. Ascites was seen in 17 patients and 15 patients who fulfilled the criteria were included. The procedure was successful in all patients. Cytology was suggestive of malignancy in 12 (80%) but not suggestive of malignancy in 3 (20%) patients. Three patients who tested negative had hyperbilirubinemia with biliary obstruction. Their ascitic fluid analysis result was also negative.
Conclusions
Random FNA of the omentum in patients with malignancy-related ascites is highly effective in the diagnosis of PC and could be employed during EUS evaluation of malignancies.

Citations

Citations to this article as recorded by

Role of Endoscopic Ultrasound in Diagnosis of Pancreatic Ductal Adenocarcinoma
Abhirup Chatterjee, Jimil Shah
Diagnostics.2023; 14(1): 78. CrossRef

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A Case of Endometriosis with Chylous Ascites: Yoon Jung Lee, M.D., Young Cheol Jo, M.D., Tae Hoon Jang, M.D., Bon Ho Ku, M.D., Chi Hoon Kim, M.D., Hye Yon Park, M.D., Kwang Hyuk Lee, M.D. and Jeong Won Lee, M.D.*; Korean J Gastrointest Endosc 2010;41(6):368-372. Published online December 30, 2010

Abstract PDF: Chylous ascites is the extravasation into the peritoneal cavity of milky chyle that is rich in triglycerides. Sixty to seventy percent of chylous ascites cases are caused by cirrhotic liver disease, congestive heart failure, or malignancy. The most common malignancy associated with chylous ascites is lymphoma. Rarely, tuberculosis has been reported as a cause of chylous ascites. Appropriately, lymphoma, ovarian cancer or tuberculosis is considered first in the differential diagnosis when a young woman of reproductive age presents with chylous ascites. Recently, we examined a 26-year-old woman who visited our hospital because of abdominal distension. Ascites tapping, esophagogastroduodenoscopy, colonoscopy and diagnostic laparoscopic biopsy led to a diagnosis of intraperitoneal endometriosis with chylous ascites. To date, some cases of endometriosis complicated by massive ascites have been reported. However, endometriosis complicated by chylous ascites has not been previously reported. The case was successfully treated using a gonadotropin-releasing hormone agonist and diuretics. (Korean J Gastrointest Endosc 2010;41:368-372)

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A Case of Eosionophilic Gastroenteritis Involving Entire Gastrointestinal Tract with Eosinophilic Ascites: Cheol Hong Park, M.D., Seung Jae Lee, M.D., Hyoung Jin Chang, M.D., Guk Jin Lee, M.D., Hyeug Lee, M.D., Hong Seok Song, M.D., Eun Jung Jeon, M.D., Jung Hwan Oh, M.D., Jeong Jo Jeong, M.D., Sang Wook Choi, M.D. and Eun Joo Seo, M.D.*; Korean J Gastrointest Endosc 2008;36(5):282-287. Published online May 30, 2008

Abstract PDF: Eosinophilic gastroenteritis is a rare condition of unknown cause characterized by pheripheral eosinophilia and eosinophilic infiltration of the gastrointestinal tract. Eosonophilic gastroenteritis is generally classified according to the layer of the gastrointestinal tract that is involved. Serosal eosinophilic infiltration is the rarest form of presentation and can result in the development of eosinophilic ascites. We experienced a case of eosinophlilic gastroenteritis involving the entire gastrointestinal tract in a 34-year-old female patient with abdominal pain that was confirmed by multiple biopsies of the gastrointestinal tract with eosinophilic ascites. The patient was successfully treated with corticosteroids. We report this case with a brief review of the literature. (Korean J Gastrointest Endosc 2008;36:282- 287)

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Clinical Feature of Pseudomembranous Colitis with Ascites: Oh Wan Kwon, M.D., Oh Young Lee, M.D., Young Il Kwon, M.D., Jae Yoon Jeong, M.D., Yoo Hum Baek, M.D., Won Moon, M.D., Jung Mi Kim, M.D., Dong Hee Koh, M.D., Hang Lak Lee, M.D., Byung Chul Yoon, M.D., Ho Soon Choi, M.D., Joon Soo Hahm, M.D., Min Ho Lee, M.; Korean J Gastrointest Endosc 2007;35(1):14-18. Published online July 30, 2007

Abstract PDF: Background
/Aims: Ascites is a fairly common condition, but the clinical features of pseudomembranous colitis with ascites are not well-known. The aim of this study was to determine how the existence of ascites is related to the clinical factors. Methods: Between March 2002 and June 2006, 67 pseudomembranous colits patients were diagnosed by performing lower endoscopy and biopsy. The patients' ascites was identified by abdominal plain radiography, ultrasonography or computerized tomography. The extension of colitis was evaluated by ultrasonography or computerized tomography. Results: 16 patients (23.9%) had ascites. The serum WBC (p=0.01), hypoalbuminemia (p＜0.01), CRP (p＜0.01), recurrence (p＜0.01), and extension of colitis (p＜0.01) were associated with the existence of ascites. The four patients who had undergone paracentesis had a low SAAG level and PMN dominant ascites. Conclusions: There were correlations of ascities with leukocytosis, hypoalbuminemia, CRP, extension of colitis and recurrence of PMC.

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A Case of Eosinophilic Gastroenteritis in a Patient with Traumatic Hypopituitarism: Seok Ju Lee, M.D., Woo Chul Chung, M.D., Kang Moon Lee, M.D., Bo In Lee, M.D., Young Chul Kim, M.D., Chang Kyun Hong, M.D., U-Im Chang, M.D.,Jin Mo Yang, M.D., Kyu Yong Choi, M.D. and In-Sik Chung, M.D.; Korean J Gastrointest Endosc 2007;34(1):51-55. Published online January 30, 2007

Abstract PDF: Eosinophilic gastroenteritis is a rare gastrointestinal disorder that can present with a variety of symptoms such as abdominal pain, vomiting, diarrhea and ascites. It is characterized by eosinophilic infiltration of the gastrointestinal wall. Its incidence has increased recently. However, the etiology and pathogenesis of this disease are not well understood. The relationship between hypopituitarism and eosinophilic gastroenteritis is unclear. A corticotropin deficiency and eosinophilia are observed in approximately 90% of traumatic hypopituitarism. We encountered a case of eosinophilic gastroenteritis with eosinophilic ascites in a patient with traumatic hypopituitarism including central diabetes incipidus. Abdominal computed tomography showed diffuse wall thickening of the esophagus, stomach and small bowel with a large amount of ascites. Cytologic examination of ascites showed heavy dense infiltration of eosinophils. The patient was treated with corticosteroid and responded rapidly. Two months later, she was admitted again with a relapse of symptoms. We report this case with a brief review of the relevant literature.

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A Case of Eosinophilic Gastroenteritis with Eosinophilic Ascites: Youn Ju Na, M.D., Ki-Nam Shim, M.D., Moon Sun Yeom, M.D., Hee Sun Kim, M.D., Sung-Ae Jung, M.D., Kwon Yoo, M.D., Il Hwan Moon, M.D. and Min Sun Cho, M.D.*; Korean J Gastrointest Endosc 2004;29(1):22-26. Published online July 30, 2004

Abstract PDF: Eosinophilic gastroenteritis is an uncommon disease characterized by the presence of abnormal gastrointestinal symptoms, eosinophilic infiltration in one or more areas of the gastrointestinal tract, an absence of the indentifiable cause of eosinophilia and the exclusion of eosinophilic involvement in organs other than gut. The etiology is unknown, and the pathogenesis is poorly understood. Clinical presentations depend on the region of gastrointestinal tract involved and the depth of bowel involvement. We experienced a case of eosinophilic gastroenteritis involving entire GI tract with eosinophilic ascites in a 72-year-old female with abdominal distention and pain. The patient was treated with corticosteroid successfully. We report this case with a brief review of the literatures. (Korean J Gastrointest Endosc 2004;29:22⁣26)

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A Case of Pseudomembraneous Colitis Associated with Ascites: Cheon Il Kang, M.D., Hyun Jeong Lee, M.D., Young Tak Kim, M.D., Young Hak Lee, M.D.,Seung Yeob Lee, M.D., Chang Min Cho, M.D., Won Young Tak, M.D., Young Oh Kweon, M.D., Sung Kook Kim, M.D., Yong Hwan Choi, M.D., Joon Mo Chung, M.D., Soo Kyung Lee, M.D.*; Korean J Gastrointest Endosc 2002;25(6):466-469. Published online December 30, 2002

Abstract PDF: Antibiotics associated colitis due to Clostridium difficile is a common nosocomial infection associated with significant morbidity. In severe cases, pseudomembraneous colitis may be associated with intraperitoneal fluid accumulation. However, the characteristics of the fluid are seldom described. This case report describes pseudomembraneous colitis patient who was presented with low serum-ascites albumin gradients and lymphocytic ascites, without the evidence of infection, malignancy, or inflammatory peritoneal disease. (Korean J Gastrointest Endosc 2002;25:466⁣469)

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A Case of Ascites by Pseudomembranous Colitis, Initially Diagnosed Malignant Asites: Chang Uck Kim, M.D., Jin Won Cho, M.D., Jin Young Song, M.D.,Do Kyun Jin, M.D., Su Jin Hong, M.D., Sea Hyub Kae, M.D.,Jin Lee, M.D. and Sang Aun Joo, M.D.; Korean J Gastrointest Endosc 2001;22(4):225-228. Published online April 30, 2001

Abstract PDF: Pseudomembranous colitis (PMC) is mostly related with the antibiotics and it presents with diarrhea, abdominal pain, fever, hypoalbuminemia and hypovolemia. In the clinical course of pseudomembranous colitis (PMC), ascites is a rare presentation, and high elevation of carcinoembryonic antigen (CEA) associated with PMC is also a very rare presentation. We experienced a case taken cephalosporin group antibiotics for six weeks and presented with fever, abdominal pain, severe diarrhea, and massive ascites. During evaluation, we found low serum-ascites albumin gradient and high level of CEA in both ascites and plasma. With the impression of hidden malignancy, the special studies were done, but PMC was only found without malignancy. After vancomycin therapy, all symptoms were relieved and CEA level declined. (Korean J Gastrointest Endosc 2001;22:225⁣228)

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증례 / 전 위장관을 침범하고 호산구성 복수를 동반한 호산구성 위장관염 ( Eosinophilic Gastroenteritis Involving Entire Gastrointestinal Tract with Eosinophilic Ascites ): Korean J Gastrointest Endosc 2001;22(3):159-163. Published online November 30, 2000

Abstract PDF: Eosinophilic gastroenteritis is a rare disease of unknown cause characterized by eosinophilic infiltration in various areas of gastrointestinal tract with gastrointestinal symptoms such as abdominal pain, vomiting, diarrhea and rarely ascites. Its clinical feature depends on the type of layer and location involved. Serosal eosinophilic infiltration, the rarest form of presentation, may result in development of eosinophilic ascites. We experienced a case of eosinophilic gastroenteritis involving entire gastrointestinal tract with eosinophilic peritoneal fluid in a 38-year-old female with abdominal distension and abdominal pain, Upper gastrointestinal endoscopy, colonoscopy, small bowel series, abdominal CT showed diffuse wall thickening from esophagus to rectum. The eosinophilic peritoneal fluid and peripheral eosinophilia were confirmed by multiple biopsies of the gastrointestinal tract, She was treated with corticosteroid and responded dramatically. We report this case with a brief review of the literatures. (Korean J Gastrointest Endosc 2001;22:159 - 163)

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내시경적 췌관 배액관 삽입과 Octreotide에 의한 췌장성 복수의 치료 ( Treatment of Pancreatic Ascites with Endoscopic Pancreatic Duct Stenting and Octreotide Injection ): Korean J Gastrointest Endosc 2000;21(2):662-665. Published online November 30, 1999

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호중구성 복수를 동반한 위막성 대장염 1예 ( A Case of Pseudomembranous Colitis Associated with Neutrocytic Ascites ): Korean J Gastrointest Endosc 2000;21(1):568-571. Published online November 30, 1999

Abstract PDF: Antibiotic associated colitis due to Clostridium difficile is a common infection associated with significant morbidity. In severe cases, Pseudomembranous colitis (PMC) may be associated with intraperitoneal fluid accumulation. Howwver, the characteristics of the liquid are seldom described. This case report describes PMC patients who were presented with low serum-ascites albumin gradients (SAAG)and neutrocytic ascites, without evidence of infectious, malignant, or inflammatory peritoneal disease. The characteristics of their fluid specimens and the possible pathogenic mechanisms are discussed. These findings suggest that PMC without bowel perforation or spontaneous bacterial peritonitis. ( Korean J Gastrointest Endosc; 21: 568-571)

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