Post written by Kambiz Kadkhodayan, MD, from the Center for Interventional Endoscopy, AdventHealth, Orlando, Florida, USA, and Shayan Irani, MD, from Virginia Mason Franciscan Health, Seattle, Washington, USA.

In recent years, EUS-guided hepaticogastrostomy (EUS-HGS) has gained traction as a reliable and safe method for definitive biliary drainage in patients who cannot undergo traditional transampullary procedures.

Here, we highlight key clinical and technical aspects of EUS-HGS using devices available in Western countries. The article is a comprehensive step-by-step technical review of EUS-HGS, and the video demonstrates high-level tips to overcome commonly encountered procedural challenges.

An understanding and implementation of the technical nuances featured in this article should help Western endoscopists navigate the complexities of EUS-HGS and ensure optimal outcomes.

We would like to thank GIE for the opportunity.

Modified prone position. Note that the right side of the patient is lowered by 10° to 20°. This lowers the antidependent (right-side) intrahepatic ducts. In this position, gravity-related pooling of contrast favors a more diffuse distribution within the biliary tree.

Read the full article online.

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