Hepaticogastrostomy

The approach targets a dilated left hepatic duct because it provides an intrahepatic route that can be reached through the stomach. Duct dilation is important because it identifies the biliary structure for puncture and facilitates access for guidewire advancement. This pathway becomes particularly useful when conventional endoscopic access to the bile ducts is difficult or unsuccessful.

After ductal puncture, the guidewire establishes and maintains a navigable path between the intrahepatic bile duct and the stomach. The stent then supports the created tract and keeps bile flowing into the gastric lumen. Together, these components convert a technically difficult access route into a controlled drainage pathway that can relieve biliary obstruction.

Rather than depending on conventional access through the usual endoscopic route, hepaticogastrostomy reaches the biliary system through the stomach and a left intrahepatic duct. This distinction matters when endoscopic retrograde cholangiopancreatography has failed or when altered gastrointestinal anatomy prevents reliable access. The technique therefore provides an alternative route for therapeutic biliary drainage.

Hepaticogastrostomy may be used for obstructive jaundice associated with either malignant or benign biliary disease. Its role is especially relevant when obstruction prevents effective bile drainage through conventional methods. By establishing drainage into the gastric lumen, the approach can address the immediate problem of impaired biliary outflow while remaining within the field of advanced therapeutic endoscopy.

The operator first uses endoscopic ultrasound to identify a dilated left hepatic duct adjacent to the stomach. The duct is punctured through the gastric wall, a guidewire is advanced, and a stent is placed across the created route. The stent maintains the tract and permits bile to drain from the intrahepatic duct into the stomach.

This procedure is particularly valuable after unsuccessful endoscopic retrograde cholangiopancreatography and in patients whose gastrointestinal anatomy has been altered. In these settings, standard access may be difficult or unavailable, yet biliary obstruction can still require drainage. Hepaticogastrostomy offers a minimally invasive option within advanced therapeutic endoscopy for relieving obstructive jaundice.