VID-THER-06: Endoscopic ultrasound-guided coiling of hepatic artery pseudoaneurysm in two stages

S40 ENDOSCOPIC ULTRASOUND / VOLUME 6 / SUPPLEMENT 1 / AUGUST 2017 failed endoscopic retrograde cholangiopancreatography. Common approaches for transmural drainage include choledochoduodenostomy and hepaticogastrostomy (HGS). In this video, we describe three patients with difficult EUS-biliogastric anastomosis and advanced interventions through the established anastomosis. Case Report: Case 1 describes a case in which a choledochogastric anastomosis was performed. A 74-year-old female presented with upper gastrointestinal bleeding with failed endoscopic hemostasis requiring surgical plication of the bleeder, closure of the pylorus and gastrojejunostomy due to a locally advanced pancreatic cancer. She then developed biliary obstruction. A EUS-guided choledochogastrostomy was then performed with a forward-viewing echoendoscope. Case 2 describes a EUS-guided salvage of a misdeployed HGS stent. EUSguided HGS was performed in a patient with unresectable gastric cancer with pyloric obstruction. During deployment, the proximal end of the stent was deployed in to the peritoneal cavity with loss of guidewire. EUS-guided HGS was then performed to the misdeployed stent. Case 3 describes a patient with 2-staged endoscopic recanalization of a stenosed surgical hepaticojejunostomy for benign distal biliary stricture via a EUS-guided HGS. In the first stage, a EUS-guided HGS was performed through the left intrahepatic duct. The video describes the second stage of the procedure where endoscopic recanalization of the surgical hepaticojejunostomy was performed a few months later. Conclusion: Advanced biliogastric anastomoses and interventions were feasible and successfully avoided surgical interventions in these patients. DOI: 10.4103/2303-9027.212299