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A case of endoscopic ultrasound-guided hepaticogastrostomy for obstructive jaundice caused by intraductal papillary mucinous neoplasm-associated pancreatobiliary fistula

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Abstract

Intraductal papillary mucinous neoplasm (IPMN) sometimes forms fistulas with other organs due to high pressure of pancreatic duct filled with huge amount of mucus. Pancreatobiliary fistula may cause obstructive jaundice due to the mucus and it is hard to manage the jaundice by endoscopic biliary stenting because of high viscosity of the bile. We report a case of IPMN with pancreatobiliary fistula managed by endoscopic ultrasound (EUS)-guided hepaticogastrostomy (HGS). The patient was 87 years old and presented with obstructive jaundice. As a transpapillary biliary stent was considered to have a risk of migration due to the absence of bile duct stenosis, a nasobiliary catheter was placed as an initial drainage. However, the catheter was frequently obstructed by mucus. The patient was intolerable for surgery because of his age. Considering the intrahepatic bile was serous, EUS-HGS was performed and jaundice improved successfully. This case study revealed that EUS-HGS might be a therapeutic option for obstructive jaundice caused by an IPMN-associated pancreatobiliary fistula.

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Abbreviations

IPMN:

Intraductal papillary mucinous neoplasm

PTBD:

Percutaneous transhepatic biliary drainage

EUS:

Endoscopic ultrasound

HGS:

Hepaticogastrostomy

TB:

Total bilirubin

γ-GTP:

Gamma-glutamyl transpeptidase

ALP:

Alkaline phosphatase

AST:

Aspartate aminotransferase

ALT:

Alanine aminotransferase

CT:

Computed tomography

MRCP:

Magnetic resonance cholangiopancreatography

ERCP:

Endoscopic retrograde cholangiopancreatography

EST:

Endoscopic sphincterotomy

ENBD:

Endoscopic nasobiliary drainage

EPLBD:

Endoscopic papillary large balloon dilation

FNA:

Fine needle aspiration

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Authors and Affiliations

  1. Department of Hepato-Biliary-Pancreatic Medicine, Department of Gastroenterology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto, Tokyo, 135-8550, Japan

    Takafumi Mie, Takashi Sasaki, Tsuyoshi Takeda, Takaaki Furukawa, Yuto Yamada, Akiyoshi Kasuga, Masato Matsuyama, Masato Ozaka & Naoki Sasahira

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  1. Takafumi Mie
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  2. Takashi Sasaki
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  3. Tsuyoshi Takeda
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  4. Takaaki Furukawa
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  5. Yuto Yamada
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  6. Akiyoshi Kasuga
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  7. Masato Matsuyama
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  8. Masato Ozaka
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  9. Naoki Sasahira
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Correspondence to Naoki Sasahira.

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Conflict of interest

Takafumi Mie, Takashi Sasaki, Tsuyoshi Takeda, Takaaki Furukawa, Yuto Yamada, Akiyoshi Kasuga, Masato Matsuyama, Masato Ozaka and Naoki Sasahira declare that they have no conflict of interest.

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All procedures followed have been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

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Mie, T., Sasaki, T., Takeda, T. et al. A case of endoscopic ultrasound-guided hepaticogastrostomy for obstructive jaundice caused by intraductal papillary mucinous neoplasm-associated pancreatobiliary fistula. Clin J Gastroenterol 14, 893–898 (2021). https://doi.org/10.1007/s12328-021-01355-0

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  • DOI: https://doi.org/10.1007/s12328-021-01355-0

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