Percutaneous Hepaticogastrostomy for Failed Endoscopic Drainage

Abstract Hepaticogastrostomy (HGS) serves as an alternative approach for biliary drainage in patients with difficult-to-cross perihilar biliary strictures. Although endoscopic ultrasound-guided HGS (EUS-HGS) has become widely accepted, it can sometimes fail due to technical challenges with duct access and guidewire manipulation. In such situations, percutaneous HGS (P-HGS) offers a valuable alternative. We report our experience with three patients treated with P-HGS between February 2020 and July 2023. Conventional percutaneous and endoscopic methods as well as EUS-HGS had failed to internalize the drainage catheter in all the cases. Technical success was achieved in all the three cases. Self-limiting bile leak was seen in one patient. Rest of the patients did not develop any major complications. After a mean follow-up of 10.3 months (range, 5–14 months), P-HGS stents were patent in all three patients. In conclusion, P-HGS is technically feasible and an effective alternative to EUS-HGS or long-term external biliary drainage for noninternalizable malignant biliary strictures.