Haba Shin, Hara Kazuo, Mizuno Nobumasa, Kuwahara Takamichi, Okuno Nozomi, Miyano Akira, Fumihara Daiki, Elshair Moaz
Department of Gastroenterology, Aichi Cancer Center Hospital, Nagoya, Japan.
Clin Endosc. 2022 May;55(3):458-462. doi: 10.5946/ce.2021.114. Epub 2021 Nov 30.
Endoscopic ultrasound (EUS)-guided hepaticogastrostomy (HGS) is widely performed not only as an alternative to transpapillary biliary drainage, but also as primary drainage for malignant biliary obstruction. For anatomical reasons, this technique carries an unavoidable risk of mispuncturing intrahepatic vessels. We report a technique for troubleshooting EUS-guided portal vein coiling to prevent bleeding from the intrahepatic portal vein after mispuncture during interventional EUS. EUS-HGS was planned for a 59-year-old male patient with unresectable pancreatic cancer. The dilated bile duct (lumen diameter, 2.8 mm) was punctured with a 19-gauge needle, and a guidewire was inserted. After bougie dilation, the guidewire was found to be inside the intrahepatic portal vein. Embolizing coils were placed to prevent bleeding. Embolization coils were successfully inserted under stabilization of the catheter using a double-lumen cannula with a guidewire. Following these procedures, the patient was asymptomatic. Computed tomography performed the next day revealed no complications.
内镜超声（EUS）引导下肝胃吻合术（HGS）不仅作为经乳头胆管引流的替代方法被广泛应用，还作为恶性胆管梗阻的主要引流手段。由于解剖学原因，该技术存在不可避免的误穿肝内血管的风险。我们报告一种用于解决EUS引导下门静脉盘绕的技术，以防止介入性EUS过程中误穿后肝内门静脉出血。计划对一名59岁不可切除胰腺癌男性患者行EUS-HGS。用19号针穿刺扩张的胆管（管腔直径2.8mm），并插入导丝。探条扩张后，发现导丝位于肝内门静脉内。放置栓塞线圈以防止出血。使用带导丝的双腔套管在导管稳定的情况下成功插入栓塞线圈。经过这些操作，患者无症状。次日进行的计算机断层扫描显示无并发症。
