Endoscopic ultrasound-guided transduodenal ERCP for hepatico-jejunostomy stricture
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AbstractA 75-year-old man was referred for management of a hepaticojejunostomy (HJS) stricture following HJS performed for a bile duct injury during cholecystectomy 3 months prior. A short-type double-balloon enteroscopy (DBE) was attempted but was unsuccessful due to inability to reach the HJS. Endoscopic ultrasound (EUS)-guided transduodenal endoscopic retrograde cholangiopancreatography (ERCP) for management of the HJS stricture was planned [1].
An EUS-guided duodenum–afferent limb bypass was first performed with a lumen-apposing metal stent (LAMS) between the duodenum and the afferent limb ([Video 1]). On EUS, the afferent limb was identified from the duodenum and punctured with a 19G needle (EZshot 3; Olympus Medical, Tokyo, Japan) ([Fig. 1]).The afferent limb was distended by infusion of 500 ml of normal saline mixed with indigo-carmine and contrast medium. Over a 0.025-inch guidewire, the delivery system of the cautery-enhanced LAMS delivery system (Hanarostent Z-EUS IT; M.I. Tech, Gyeonggi-do, South Korea) was inserted and a 16 × 20-mm stent was deployed into the afferent limb ([Fig. 2], [Fig. 3]) [2]. ERCP was subsequently performed after 3 days with a dual-channel endoscope inserted into the afferent limb via the LAMS. The HJS ([Fig. 4]) was dilated with a 6-mm biliary balloon (Hurricane Biliary RX; Boston Scientific, Marlborough, Massachusetts, USA). Two plastic stents were inserted into bilateral intrahepatic ducts.
An EUS-guided duodenum–afferent limb bypass was first performed with a lumen-apposing metal stent (LAMS) between the duodenum and the afferent limb ([Video 1]). On EUS, the afferent limb was identified from the duodenum and punctured with a 19G needle (EZshot 3; Olympus Medical, Tokyo, Japan) ([Fig. 1]).The afferent limb was distended by infusion of 500 ml of normal saline mixed with indigo-carmine and contrast medium. Over a 0.025-inch guidewire, the delivery system of the cautery-enhanced LAMS delivery system (Hanarostent Z-EUS IT; M.I. Tech, Gyeonggi-do, South Korea) was inserted and a 16 × 20-mm stent was deployed into the afferent limb ([Fig. 2], [Fig. 3]) [2]. ERCP was subsequently performed after 3 days with a dual-channel endoscope inserted into the afferent limb via the LAMS. The HJS ([Fig. 4]) was dilated with a 6-mm biliary balloon (Hurricane Biliary RX; Boston Scientific, Marlborough, Massachusetts, USA). Two plastic stents were inserted into bilateral intrahepatic ducts.
All Author(s) ListTeh JL, Chan SM, Yip HC, Teoh AYB
Journal nameEndoscopy
Year2024
Month12
Volume Number56
Issue NumberS01
PublisherThieme Publishing
PagesE25 - E26
ISSN0013-726X
LanguagesEnglish-United Kingdom
