Transgastric biliary brushing

Amy Tyberg, MD, from the Division of Gastroenterology and Hepatology at Weil Cornell Medical College, Cornell University in New York, New York, USA shares this VideoGIE case “Transgastric biliary brushing: a novel endoscopic technique.”

This video describes a case of a patient with a history of pancreatic cancer status-post whipple procedure who presented with obstructive jaundice and concern for pancreatic cancer recurrence. Single balloon enteroscopy failed to reach the anastomosis, so endoscopic ultrasound (EUS)-guided drainage was performed. Through an EUS-guided technique, the anastomosis was able to be crossed and stented in an antegrade manner. Additionally, antegrade tissue sampling with a cytology brush was successfully performed and able to yield a diagnosis of recurrent malignancy.

This video highlights the expanding diagnostic and therapeutic applications of EUS. By using an EUS-guided technique, this patient was able to achieve biliary decompression without the need for surgical or percutaneous intervention. Additionally, a diagnosis was able to be made using a novel technique of advancing a biliary cytology brush from the stomach, across a hepaticogastrostomy fistulous tract, through the intra-hepatic ducts, and across the anastomosis, again avoiding the need for a more invasive sampling procedure.

We hope that videos such as this will help other endoscopists come to appreciate the expanding role of interventional and therapeutic EUS in providing minimally invasive, alternative treatments to patients who would otherwise be subjected to more invasive interventions.

Find more VideoGIE cases online.

The information presented in Endoscopedia reflects the opinions of the authors and does not represent the position of the American Society for Gastrointestinal Endoscopy (ASGE). ASGE expressly disclaims any warranties or guarantees, expressed or implied, and is not liable for damages of any kind in connection with the material, information, or procedures set forth.

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