# Endoscopic Ultrasound-Guided Hepaticogastrostomy for a Benign Biliary Stricture in a Patient Allergic to Both Iodinated and Gadolinium Contrast Media: A Case Report

## TL;DR

A new method for biliary drainage was used in a patient allergic to common contrast agents, avoiding complications and improving liver function.

## Contribution

EUS-HGS is presented as a safe alternative for biliary drainage in patients with allergies to iodinated and gadolinium contrast media.

## Key findings

- EUS-HGS was successfully performed without contrast agents in a patient with dual allergies.
- The patient's hepatobiliary enzyme levels improved significantly after the procedure.
- The procedure was complication-free and effective for biliary drainage.

## Abstract

Allergic reactions to iodinated and gadolinium contrast media, though rare, present significant challenges in managing biliary obstructions. This case report describes a novel approach to biliary drainage in a patient with such allergies using endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS). An 81-year-old woman with multiple allergies, including to both iodinated and gadolinium contrast media, developed a benign biliary stricture following repeated radiofrequency ablation for hepatocellular carcinoma. Standard endoscopic retrograde cholangiopancreatography was contraindicated due to these allergies. An EUS-HGS was successfully performed, achieving effective biliary drainage through ultrasound-guided puncture and stent placement without the use of contrast agents. The procedure was complication-free, and the patient’s hepatobiliary enzyme levels improved significantly postoperatively. An EUS-HGS offers a safe and effective alternative for biliary drainage in patients with dual contrast agent allergies, especially when conventional methods are not viable. This case highlights the potential of EUS-HGS in addressing complex clinical challenges.