Case Report Endoscopic Ultrasound-Guided Hepaticogastrostomy Is Effective for Repeated Recurrent Cholangitis after Surgery: Two Case Reports Akihiro Matsumi , Hironari Kato, Yousuke Saragai, Sho Mizukawa, Saimon Takada, Shinichiro Muro, Daisuke Uchida , Takeshi Tomoda, Kazuyuki Matsumoto , Masaya Iwamuro, Shigeru Horiguchi, Yoshiro Kawahara, and Hiroyuki Okada Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Gastroenterology and Hepatology, 2-5-1 Shikata-cho, Kita-ku, Okayama City, Okayama 700-8558, Japan Correspondence should be addressed to Akihiro Matsumi; akihiro.matsumi.gastro@gmail.com Received 11 March 2018; Accepted 17 May 2018; Published 10 June 2018 Academic Editor: Yoshihiro Moriwaki Copyright © 2018 Akihiro Matsumi et al. Tis is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. We report the cases of two patients who underwent endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) using metallic stents (MS) for recurrent cholangitis due to benign biliary stenosis. Te patients had repeatedly undergone double-balloon endoscopy and anastomotic stenosis. Tus, EUS-HGS was performed. Te procedures were successful, and placement of a covered metallic stent (C-MS) relieved cholangitis. Te occurrence of cholangitis was subsequently considerably reduced. For patients with postoperative recurrent cholangitis, EUS-HGS with MS should be considered because of its efcacy and safety. 1. Introduction Endoscopic ultrasound-guided biliary drainage (EUS-BD) is now an established technique and is mainly used in patients who fail endoscopic retrograde cholangiopancreatography (ERCP) or in those with reconstructed gastrointestinal anatomy [1]. EUS-BD has been reported in patients with malignant biliary stenosis, but there are few reports in those with benign biliary stenosis [2–5]. We herein describe two cases of endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) using metallic stents (MS) for patients with recurrent cholangitis due to benign biliary stenosis. 2. Case Reports 2.1. Case 1. A 58-year-old man underwent pancreatoduo- denectomy and right hepatic lobectomy with choledocho- jejunostomy for a duodenal gastrointestinal stromal tumor with multiple liver metastases. Ten years afer the operation, he developed recurrent fever and upper abdominal pain with hepatobiliary enzyme elevation. He underwent double- balloon endoscopy (DBE) and anastomotic stenosis was revealed. Tere was no evidence of malignancy, and we diagnosed cholangitis due to benign anastomotic stenosis. Balloon dilation for stenosis and biliary stenting with a plastic stent (PS) was performed. As relapsing cholangitis occurred 6 times a year, he underwent EUS-HGS with MS. We used a GF Type UCT 260 (Olympus Medical Systems, Tokyo, Japan) endoscope. Te B3 duct was visualized from the stomach. Afer the absence of blood vessels crossing the puncture route was confrmed, the bile duct was punctured with a 19-G needle (EZ shot 3; Olympus) (Figure 1(a)). Ten, a 0.025-inch guidewire (VisiGlide 2; Olympus) was introduced into the jejunum in an antegrade manner. Subsequently, the puncture site was dilated with a 3.6-Fr double-lumen catheter (Uneven Double Lumen Catheter; PIOLAX, Tokyo, Japan), and another 0.035-inch wire (Revowave; PIOLAX, Tokyo, Japan) was introduced into the jejunum (Figure 1(b)). Hindawi Case Reports in Gastrointestinal Medicine Volume 2018, Article ID 7201967, 3 pages https://doi.org/10.1155/2018/7201967