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.
Keywords: allergic; endoscopic retrograde cholangiopancreatography (ercp); endoscopic ultrasound-guided hepaticogastrostomy; gadolinium contrast; iodinated contrast media.
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