Hepaticogastrostomy guided by real-time contrast-enhanced harmonic endoscopic ultrasonography: a novel technique

Endoscopic ultrasonography-guided hepaticogastrostomy (EUS-HGS) has recently been developed as an alternative biliary drainage technique for failed endoscopic retrograde cholangiopancreatography (ERCP) [1] [2] [3]. A recent review revealed its overall technical success rate to be 82 % [4], but puncturing the left intrahepatic bile duct (LIBD) is occasionally challenging. Here we present a case in which EUS-HGS was successfully performed under real-time contrast-enhanced harmonic EUS guidance.