Case Report
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Portal cavernography during endoscopic retrograde cholangiopancreatography: from bilhemia to hemobilia
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Rawad A. Yared, Paraskevas Gkolfakis, Arnaud Lemmers, Vincent Huberty, Thierry Degrez, Jacques Devière, Daniel Blero
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Clin Endosc 2023;56(4):521-526. Published online January 5, 2023
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DOI: https://doi.org/10.5946/ce.2021.276
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- Portobiliary fistulas are rare but may lead to life-threatening complications. Biliary plastic stent-induced portobiliary fistulas during endoscopic retrograde cholangiopancreatography have been described. Herein, we present a case of portal cavernography and recurrent hemobilia after endoscopic retrograde cholangiopancreatography in which a portobiliary fistula was detected in a patient with portal biliopathy. This likely indicates a change in clinical presentation (from bilhemia to hemobilia) after biliary drainage that was successfully treated by placement of a fully covered, self-expandable metallic stent.
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Citations
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- Recognition and management of stent malposition in the portal vein during endoscopic retrograde cholangiopancreatography: A case report
Rui Wu, Feng Zhang, Hao Zhu, Ming-Dong Liu, Yu-Zheng Zhuge, Lei Wang, Bin Zhang
World Journal of Gastrointestinal Endoscopy.2024; 16(7): 432. CrossRef
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Focused Review Series: Recent Updates on the Role of EUS in Pancreatobiliary Disease
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What You Need to Know Before Performing Endoscopic Ultrasound-guided Hepaticogastrostomy
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Tanyaporn Chantarojanasiri, Thawee Ratanachu-Ek, Nonthalee Pausawasdi
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Clin Endosc 2021;54(3):301-308. Published online May 28, 2021
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DOI: https://doi.org/10.5946/ce.2021.103
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- Endoscopic retrograde cholangiopancreatography (ERCP) is the primary treatment modality for bile duct obstruction. When ERCP is unsuccessful, percutaneous transhepatic biliary drainage can be an alternative method. Endoscopic ultrasound-guided biliary drainage (EUS-BD) has emerged as a treatment option for biliary obstruction, especially after ERCP failure. EUS-BD offers transluminal intrahepatic and extrahepatic drainage through a transgastric and transduodenal approach. EUS-guided hepaticogastrostomy (EUS-HGS) is an excellent choice for patients with hilar strictures or those with a surgically altered anatomy. The optimal steps in EUS-HGS are case selection, bile duct visualization, puncture-site selection, wire insertion and manipulation, tract dilation, and stent placement. Caution should be taken at each step to prevent complications. Dedicated devices for EUS-HGS have been developed to improve the technical success rate and reduce complications. This technical review focuses on the essential practical points at each step of EUS-HGS.
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Citations
Citations to this article as recorded by

- Use of a novel screw-type dilator for endoscopic ultrasonography-guided hepaticogastrostomy via 22-gauge needle and 0.018-inch guidewire.
Shin Kato, Mariko Tsukamoto, Taichi Murai, Yuta Koike
Revista Española de Enfermedades Digestivas.2024;[Epub] CrossRef - Transbulbäre und transgastrale Gallengangsdrainage
Philipp Thies, Markus Dollhopf
Gastroenterologie up2date.2024; 20(01): 69. CrossRef - 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
Clinical Endoscopy.2024; 57(2): 246. CrossRef - Risk factors for recurrent stenosis after balloon dilation for benign hepaticojejunostomy anastomotic stricture
Takafumi Mie, Takashi Sasaki, Takeshi Okamoto, Tsuyoshi Takeda, Chinatsu Mori, Yuto Yamada, Takaaki Furukawa, Akiyoshi Kasuga, Masato Matsuyama, Masato Ozaka, Naoki Sasahira
Clinical Endoscopy.2024; 57(2): 253. 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 - EUS-guided hepaticogastrostomy: practical tips and tricks
Kambiz Kadkhodayan, Shayan Irani
VideoGIE.2024; 9(9): 417. CrossRef - A Possible Contraindication for Endoscopic Ultrasound-Guided Hepaticogastrostomy: A Giant Hiatal Hernia
Koichiro Mandai, Shiho Nakamura
Cureus.2024;[Epub] CrossRef - Endoscopic ultrasound-guided intervention for inaccessible papilla in advanced malignant hilar biliary obstruction
Partha Pal, Sundeep Lakhtakia
Clinical Endoscopy.2023; 56(2): 143. CrossRef - Liver impaction technique improves technical success rate of guidewire insertion during EUS-guided hepaticogastrostomy (with video)
Junichi Nakamura, Takeshi Ogura, Saori Ueno, Atsushi Okuda, Nobu Nishioka, Yuki Uba, Mitsuki Tomita, Kimi Bessho, Nobuhiro Hattori, Hiroki Nishikawa
Therapeutic Advances in Gastroenterology.2023;[Epub] CrossRef - Therapeutic endoscopic ultrasound: European Society of Gastrointestinal Endoscopy (ESGE) Technical Review
Roy L. J. van Wanrooij, Michiel Bronswijk, Rastislav Kunda, Simon M. Everett, Sundeep Lakhtakia, Mihai Rimbas, Tomas Hucl, Abdenor Badaoui, Ryan Law, Paolo Giorgio Arcidiacono, Alberto Larghi, Marc Giovannini, Mouen A. Khashab, Kenneth F. Binmoeller, Marc
Endoscopy.2022; 54(03): 310. CrossRef - Practical Tips for Safe and Successful Endoscopic Ultrasound-Guided Hepaticogastrostomy: A State-of-the-Art Technical Review
Saburo Matsubara, Keito Nakagawa, Kentaro Suda, Takeshi Otsuka, Masashi Oka, Sumiko Nagoshi
Journal of Clinical Medicine.2022; 11(6): 1591. CrossRef - Prevention of Serious Complications during Endoscopic Ultrasound-Guided Biliary Drainage: A Case-Based Technical Review
Surinder Singh Rana, Jimil Shah, Harish Bhujade, Ujjwal Gorsi, Mandeep Kang, Rajesh Gupta
Journal of Digestive Endoscopy.2022; 13(02): 082. CrossRef
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Original Article
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Efficacy of Nasobiliary Tubes and Biliary Stents in Management of Patients with Bile Leak after Liver Transplantation: A Systematic Review
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Ali Raza, Anam Omer, Sara Iqbal, Vineet Gudsoorkar, Pramoda Koduru, Kumar Krishnan
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Clin Endosc 2019;52(2):159-167. Published online March 29, 2019
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DOI: https://doi.org/10.5946/ce.2018.118
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- Background
/Aims: Bile leak is one of the most common complications of liver transplantation. The treatment options for bile leaks include conservative management, surgical re-intervention, percutaneous drainage and endoscopic drainage. We aimed to perform a systematic review to identify the efficacy of endoscopic treatment in the resolution of post-transplant bile leaks. Methods: Two independent reviewers performed systematic literature search in PubMed, ISI Web of Science, grey literature and relevant references in May 2017. Human studies in English with documented post-liver transplant bile leaks were included. Results: Thirty-four studies were included in the final analysis. The pooled efficacy of biliary stents for the resolution of post-transplant bile leaks was 82.43% compared with 87.15% efficacy of nasobiliary tubes. The efficacy of biliary stents was lower for anastomotic leaks (69.23%) compared to T-tube (90.9%) or cut-surface/ cystic duct stump related leaks (92.8%). Similarly, the efficacy of nasobiliary tube was also lower for anastomotic leaks (58.33%) compared to T-tube or cut-surface related leaks (100%). Conclusions: In this systematic review, the overall efficacy was 82.43% in biliary stent group, and 87.15% in nasobiliary tube group. Both biliary stent and nasobiliary tube were more effective in managing non-anastomotic leaks compared to anastomotic leaks.
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Citations
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- Lesson learnt from 60 years of liver transplantation: Advancements, challenges, and future directions
Eyad Gadour
World Journal of Transplantation.2025;[Epub] CrossRef - Application of percutaneous biliary drainage in the treatment of post-operative bile leakage after liver rupture: A case report
Jinlong Chen, Zhikuan Wang, Lixin Zhang, Xi Chen, Yuanyuan Liu, Hong Chen, Xiaoqiang Tong, Yanchao Dong
Journal of Minimal Access Surgery.2024;[Epub] CrossRef - A nomogram for prediction of ERCP success in patients with bile duct leaks: a multicenter study
De-xin Chen, Sheng-xin Chen, Sen-lin Hou, Gui-hai Wen, Hai-kun Yang, Da-peng Shi, Qing-xin Lu, Ya-qi Zhai, Ming-yang Li
Surgical Endoscopy.2024; 38(5): 2465. CrossRef - Complications in Post-Liver Transplant Patients
Carlotta Agostini, Simone Buccianti, Matteo Risaliti, Laura Fortuna, Luca Tirloni, Rosaria Tucci, Ilenia Bartolini, Gian Luca Grazi
Journal of Clinical Medicine.2023; 12(19): 6173. CrossRef - Nasobiliary drainage: an effective treatment for pruritus in cholestatic liver disease
Wafaa Ahmed, Rebecca Jeyaraj, David Reffitt, John Devlin, Abid Suddle, John Hunt, Michael A Heneghan, Phillip Harrison, Deepak Joshi
Frontline Gastroenterology.2022; 13(5): 416. CrossRef - A case of combined use of endoscopic drainage and percutaneous drainage for traumatic liver injury type III b
Shigekuni Okumura, Jun Oda, Yousuke Minami, Masaru Hirayama, Kennta Aida
Journal of the Japanese Society of Intensive Care Medicine.2021; 28(3): 210. CrossRef - Biliary Complications Following Adult Deceased Donor Liver Transplantation: Risk Factors and Implications at a High-volume US Center
Abraham J. Matar, Katie Ross-Driscoll, Lisa Kenney, Hannah K. Wichmann, Joseph F. Magliocca, William H. Kitchens
Transplantation Direct.2021; 7(10): e754. CrossRef - The Need for a Better-Designed Study of the Outcomes of Endoscopic Management of Bile Leak
Hyung Ku Chon, Eun Ji Shin, Seong-Hun Kim
Clinical Endoscopy.2020; 53(6): 633. CrossRef
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Case Report
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Cholangitis Secondary to Food Material Impaction in the Common Bile Duct through a Choledochoduodenal Fistula
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Bong-Koo Kang, Sung Min Park, Byung-Wook Kim, Joon Sung Kim, Ji Hee Kim, Jeong-Seon Ji, Hwang Choi
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Clin Endosc 2015;48(3):265-267. Published online May 29, 2015
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DOI: https://doi.org/10.5946/ce.2015.48.3.265
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Biliary-enteric communications caused by duodenal ulcers are uncommon, and choledochoduodenal fistula (CDF) is by far the most common type. Usually in this situation, food material does not enter the common bile duct because the duodenal lumen is intact. Here, we report a case in which cholangitis occurred due to food materials impacted through a CDF. Duodenal obstruction secondary to duodenal ulcer prevented food passage into the duodenum in this case. Surgical management was recommended; however, the patient refused surgery because of poor general condition. Consequently, the patient expired with sepsis secondary to ascending cholangitis.
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Citations
Citations to this article as recorded by

- Stone-Induced Purulent Choledocoduodenal Fistula Presenting with Ascending Cholangitis
Christienne Shams, Michael Cannon, Jared Bortman, Seifeldin Hakim
ACG Case Reports Journal.2018; 5(1): e60. CrossRef - Successful Conservative Treatment of a Cholecystoduodenal Fistula Caused by a Cytomegalovirus-associated Duodenal Ulcer
Hideki Mori, Moriya Zakimi, Shin Kato, Koki Yamada, Kenji Chinen, Tomiaki Kubota, Masayuki Arashiro, Susumu Shinoura, Kaoru Kikuchi
Internal Medicine.2016; 55(18): 2617. CrossRef
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A Case of Duodenobiliary Fistula Caused by a Metal Stent in a Patient with Hepatocellular Carcinoma
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Seok Bae Yoon, M.D., Hong Sik Lee, M.D., Hyuk Soon Choi, M.D., Hye Jin Cho, M.D., Tae Jung Yun, M.D., Jin Nam Kim, M.D., Ik Yoon, M.D. and Chang Duck Kim, M.D.
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Korean J Gastrointest Endosc 2009;39(5):324-327. Published online November 30, 2009
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- Biliary drainage can improve the quality of life in a patient with obstructive jaundice caused by malignancy. Biliary metal stent insertion is a very useful method because it drains the bile physiologically and patients have little discomfort with the procedure. It has a few complications such as restenosis, liver perforation, bowel perforation, fistula formation and stent dislocation. Perforation and fistula formation are caused by pressure due to the self expanding characteristics of the metal stent. We report here on a case of duodenobiliary fistula that was caused by a biliary metal stent in a patient suffering with hepatocellula carcinoma, and we also include a review of the relevant literature. (Korean J Gastrointest Endosc 2009; 39:324-327)
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A Case of Choledocho-Duodeno-Colonic Fistula
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Jeong Sook Seo, M.D., Sung Yeun Yang, M.D., Jae Hwan Kim, M.D., Su Kyoung Kwon, M.D., Sang Bun Choi, M.D., Su Kyoung Jo, M.D., Yang Cheon Han, M.D. and Eun Ju Lee, M.D.
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Korean J Gastrointest Endosc 2007;34(5):278-281. Published online May 30, 2007
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- Biliary-enteric fistula is a rare disease, and the common causes of biliary-enteric fistula are gallstone, peptic ulcer, malignancy and trauma. It is known that the most common type of biliary-enteric fistula is the cholecysto- duodenal fistula, yet the combination of choledocho- duodeno-colonic fistula is a rare finding. A 78-year-old woman was admitted because she had suffered with right upper quadrant pain, a febrile sense and chills for 2 days. We confirmed the choledocho-duodeno-colonic fistula by performing gastroduodenoscopy, abdominal CT and an upper GI series. So, we report here on an usual case of choledocho-duodeno-colonic fistula, along with a review of the relevant literatures. (Korean J Gastrointest Endosc 2007;34:278281)
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A Case of Iatrogenic Bronchobiliary Fistula
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Hee Bok Chae, M.D., Ki Won Moon, M.D., Sang Seok Bae, M.D., Seon Mee Park, M.D., Sei Jin Youn, M.D., Il Hun Bae, M.D.*, Jae Woon Choi, M.D.† and Jun Ho Wang, M.D.‡
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Korean J Gastrointest Endosc 2004;28(3):151-155. Published online March 31, 2004
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- Bronchobiliary fistula is a rare condition. It is defined by the presence of a passage between the biliary tract and the bronchial tree. Many conditions can give rise to the developement of such a communication. The patient was a 71-year-old man who had obstructive jaundice due to liver mass. At first, we inserted an uncovered metallic stent for biliary drainage. However, the bile duct was perforated due to the trapping of a catheter in the distal end of the deployed stent. The operation was performed immediately, but only the sump draingage was placed in the retroperitoneum because the perforation site could not be found. After 20 days from the procedure, the patient complained of bilioptysis because of a bronchobiliary fistula. We inserted a covered stent into the previous uncovered metallic stent. Bilioptysis rapidly resolved after the successful procedure. We report a case of iatrogenic bronchobiliary fistula which was managed by endoscopic biliary stenting. (Korean J Gastrointest Endosc 2004;28:151155)
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간암 절제술 후 후기 합병증으로 발생한 기관지담관루의 치료 1 예 ( Bronchobiliary Fistula as a Late Complication of Hepatic Resection )
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Korean J Gastrointest Endosc 2001;23(2):127-131. Published online November 30, 2000
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- A bronchobiliary fistula (BBF), which is defined by an abnormal communication between the biliary system and the bronchial tree, is an uncommon complication after hemihe-patectomy, trauma, hydatid disease, choledocholithiasis, and other causes of biliary obstruction, BBF are rare complication of hepatic resection that can present from days to years after operation. Management of fistula is often very difficult and can be associated with high morbidity and mortality rates. Early recognition and proper management are essential to avoid a fatal outcome. Endoscopic retrograde cholangiopancreatography (ERCP) and percutaneous trans-hepatic cholangiography (PTC) are the diagnostic studies of choice and offer the possibility of therapeutic intervention. Although large series in the literature emphasize the surgical management of BBF, the reoperative procedures tend to be complicated, with a significant morbidity and mortality. Nonsurgical intervention via ERCP or PTC are more recently notably successful when resolution of a distal biliary obstruction is accomplished. Only after aggressive attempts at nonoperative, interventional techniques have failed should operative approaches be entertained. We are reporting a case of BBF secondary to hepatic resection of hepatocellular carcinoma which was managed by surgical operation, (Korean J Gastrointest Endosc 2001;23:127-131)
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췌관 결석에 동반된 췌담관 누공 1예 ( A Case of a Pancreaticobiliary Fistula Accompanied by Pancreatic Duct Stones )
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Korean J Gastrointest Endosc 2000;20(3):231-234. Published online November 30, 1999
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- A Pancreaticobiliary fistula is a rare complication of acute necrotizing pancreatitis or pancreatic abscess. One case is herein reported of pancreaticobiliary fistula that was found following removal of pancreatic duct stones by extracorporeal shock-wave lithotripsy and endoscopic sphincterotomy. The patient was a 53-year old woman who was admitted with epigastric pain and fever. Endoscopic retrograde pancreatography revealed multiple stones in the main pancreatic duct. Pus from the pancreatic duct was drained through the major papilla during cannulation. On balloon cholangiogram obtained after removal of the stones, a direct fistulous connection between the main pancreatic duct and distal common bile duct was noted. It is speculated that pancreatic abscess or mechanical compression of pancreatic duct stones may contribute to the destruction of the intrapancreatic bile duct, which leads to the formation of a pancreaticobiliary fistula.
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증례 : 담도 췌장 ; 간절제술 후 발생한 기관지 담도 누공 1예 ( Case Reports : Biliary Tract & Pancreas ; Bronchobiliary Fistula Secondary to Hepatic Resection - Treatment by endoscopic retrograde biliary drainage - )
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Korean J Gastrointest Endosc 1997;17(2):220-225. Published online November 30, 1996
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- Bronchobiliary fistula (BBF) is a rare disorder, defined as opening of a passage between the bronchial tree and the biliary tract and presence of bile in the sputum (biloptysis). BBF usually occurs either in the congenital form or following multiple causes, including mainly thoracoabdominal trauma, liver abscess, parasitic liver disease, choledocholithiasis, and post operative biliary stenosis. The cardinal clinical features were respiratory symptoms, jaundice, and cholangitis. Management of fistula is often very difficult and can be associated with high morbidity and mortality rates. Early recognition and proper management are essential to avoid a fatal outcome. To date, surgery has been favored as the most efficient therapeutic option, although percutmeous approaches, and more recently, endoscopic sphincterotomy and stent insertion, have succeeded in resolving certain kind of BBF. We are reporting a case of BBF secondary to hepatic resection of hepatocelluar carcinoma which was managed by endoscopic retrograde biliary stenting for keeping optimal bile drainage and surgical operation for resection of recurred tumor and removal of subphrenic abscess, (Korean J Gastrointest Endosc 17: 220-224, 1997)