Endoscopic ultrasound-guided hepaticogastrostomy by puncturing both B2 and B3: a single center experience.

Endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) through ducts B2 or B3 is effective in most patients with biliary obstruction, because B2 and B3 commonly join together. However, in some patients, B2 and B3 do not join each other due to invasive hilar tumors; therefore, single-route drainage is insufficient. Here, we investigated the feasibility and efficacy of EUS-HGS through both B2 and B3 simultaneously in seven patients.

Impact of socioeconomic status and sibling number on the prevalence of infection: a cross-sectional study in a Japanese population.

infection is a significant risk factor for gastric cancer. The infection is acquired mainly in early childhood and is influenced by environmental factors, including socioeconomic status and sibling number. However, the impact of socioeconomic status and sibling number on infection has not been well studied in Japan.

B2 puncture with forward-viewing EUS simplifies EUS-guided hepaticogastrostomy (with video).

Background And Objectives: EUS-guided hepaticogastrostomy (EUS-HGS) is in widespread use; however, there are few dedicated devices. The B2 route is technically easier than the B3 route for guidewire insertion, dilation, and stenting but if performed with conventional oblique-viewing (OV) EUS, B2 puncture can cause transesophageal puncture and severe adverse events. The aim of this study was to assess the efficacy of forward-viewing (FV) EUS, which we have developed to improve safety for B2 puncture in EUS-HGS (B2-EUS-HGS).

Endoscopic ultrasound-guided portal vein coiling: troubleshooting interventional endoscopic ultrasonography.

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.

Utility of stent-in-stent technique in management of post-pancreatitis splenic abscess using forward-viewing echoendoscope.

Highlight Elshair and colleagues describe a novel technique which could be applied for drainage of any paragastric fluid collection, including pseudocyst and abscess. In comparison to the oblique-view echoendoscope, the forward-viewing echoendoscope allows concurrent stent-in-stent placement over the same axis. Double-pit stent deployment inside the metal stent prevents bleeding and metallic-stent kinking.

Outcomes of Endoscopic Ultrasound-Guided Biliary Drainage in Patients Undergoing Antithrombotic Therapy.

Background/aims: The Japan Gastroenterological Endoscopy Society (JGES) has published guidelines for gastroenterological endoscopy in patients undergoing antithrombotic treatment. These guidelines classify endoscopic ultrasound-guided biliary drainage (EUS-BD) as a high-risk procedure. Nevertheless, the bleeding risk of EUS-BD in patients undergoing antithrombotic therapy is uncertain.

Use of double biopsy forceps: A novel technique for safe removal of migrating stent after EUS-guided pancreatic drainage.

Highlight For migrating stent removal, Elshair and colleagues recommend using a double-channel scope and two biopsy forceps. The stent is fixed with one of the forceps and its proximal end is caught with the other while applying countertraction. The proximal end is cut, and the stent is safely removed through the duodenum.