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Create a Free AccountAnatomy - Hepatopancreatobiliary
A case of endoscopic minor duodenal papillectomy after pancreatic stent placement using an endoscopic ultrasonography-guided rendezvous method
Endoscopic papillectomy is a minimally invasive procedure for duodenal papillary tumors. However, it is often associated with adverse events, such as postprocedural pancreatitis, bleeding, and duodenal perforation. Although postprocedural pancreatitis is a major problem, the placement of a pancreatic plastic stent (p-PS) can reduce the risk of pancreatitis. Generally, a p-PS is inserted after endoscopic papillectomy; however, the procedure can be unsuccessful.1 We used the inside pancreatic stenting papillectomy method to insert a p-PS.Cholangioscopy and double-balloon enteroscopy mediated “sandwich puncture” of a completely closed choledochojejunostomy
Postoperative stricture after choledochojejunostomy is usually treated by (1) a percutaneous transhepatic approach, (2) balloon-assisted enteroscopy, or (3) interventional EUS.1 However, if the anastomosis is completely closed, it cannot be endoscopically expanded and must be surgically reopened. Although blind puncture2 and magnetic compression3 have been proposed as nonsurgical alternatives, they are not yet common procedures, and both carry risks such as perforation and major bleeding.Electrohydraulic lithotripsy through a fistula of EUS-guided hepaticogastrostomy: a new approach for right intrahepatic stones
A 50-year-old man with a history of hepaticojejunostomy and Roux-en-Y reconstruction for congenital biliary dilatation presented with repeated episodes of cholangitis due to bilateral intrahepatic stones (Fig. 1). An approach to hepaticojejunostomy anastomosis by double-balloon endoscope failed because of intestinal adhesions and a long afferent loop, and percutaneous transhepatic biliary access was impossible because of poor US visualization of the intrahepatic bile duct (IHBD), which was not dilated on MRCP.Endoscopic removal of a migrated plastic stent from the peritoneal cavity after an EUS-guided gallbladder drainage procedure
EUS-guided gallbladder drainage is useful as palliative therapy for acute cholecystitis but is associated with adverse events such as biliary peritonitis, abdominal bleeding, intestinal injury, and stent migration. Stent migration is a particularly severe adverse event because it frequently necessitates surgical removal of the stent.1 We report here a case in which a migrated stent in the peritoneal cavity was removed endoscopically under fluoroscopic guidance.Electrohydraulic lithotripsy under double-balloon endoscope–assisted direct cholangioscopy for treatment of choledocholithiasis in a patient with Roux-en-Y gastrectomy
Electrohydraulic lithotripsy (EHL) has been effective for fragmentation of large bile duct stones, but it requires direct visualization of the bile duct. A double-balloon endoscope (DBE) facilitates access to the biliary system in patients with surgically altered anatomy, and the feasibility of DBE-assisted cholangioscopy with use of an ultraslim upper endoscope has been reported. Herein, we present a case in which multiple bile duct stones were successfully removed by EHL under DBE-assisted direct transpapillary cholangioscopy.
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