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Create a Free AccountProcedures - ERCP/Cholangioscopy
With a little help from my friends: percutaneously assisted internalization of a biliary drain
EUS-guided hepaticogastrostomy (EUS-HG) provides endoscopic biliary drainage when conventional techniques are not feasible.1 While comparable to percutaneous transhepatic drainage in regard to safety and efficacy,2 endoscopic drainage forgoes the need for cumbersome external drain hardware and promotes physiologic enterohepatic circulation of bile.3 In the absence of biliary dilation, the procedure can be technically challenging because access to the biliary tree is commonly obtained transgastrically with EUS-guided puncture of the left intrahepatic ducts.Endoscopic nasobiliary drainage tube placement through a periampullary perforation for management of intestinal leak and necrotizing pancreatitis
Periampullary perforation has a high mortality rate.1,2 Endoscopic management, including a biliary stent placement into the common bile duct (CBD) and hemostatic clips, can treat the periampullary perforation.3,4 However, it can be difficult to close the perforation and prevent the intestinal juice leakage in the case of the perforation with severe inflammation.EUS-directed transenteric ERCP–assisted internalization of a percutaneous biliary drain in Roux-en-Y anatomy
Endoscopic ultrasound–directed transenteric ERCP (EDEE) has recently been described as a safe, effective procedure to obtain biliary access in patients with Roux-en-Y anatomy.1,2 Here, we present a video case report of EDEE-assisted biliary drain internalization in a patient with prior liver transplant and Roux-en-Y hepaticojejunostomy (HJ), presenting with HJ anastomotic stricture (Video 1, available online at www.giejournal.org ).EUS-Guided hepaticogastrostomy in a pregnant patient with Roux-en-Y hepaticojejunostomy anatomy
Endoscopic ultrasound–guided hepaticogastrostomy (EUS-HGS) is a therapeutic biliary drainage procedure that can be utilized as an alternative procedure in patients who fail conventional ERCP and have sufficiently dilated left-sided biliary ducts. Herein, we describe an EUS-HGS to obtain biliary drainage in a pregnant patient with previous Roux-en-Y hepaticojejunostomy (RYHJ) reconstruction.Magnetic compression anastomosis for treatment of biliary stricture after cholecystectomy
Postcholecystectomy biliary stricture can be treated with endoscopic or percutaneous treatments. However, these conventional methods are not feasible if a guidewire cannot be passed through the stricture.1-6 We report magnetic compression anastomosis for the treatment of a biliary stricture after cholecystectomy that could not be treated with conventional methods (Video 1, available online at www.VideoGIE.org ).Afferent limb syndrome, biliocutaneous fistula, bilioenterocutaneous fistula, dehiscence of the hepaticojejunostomy: Can we treat all of this endoscopically?
Afferent limb syndrome can occur from benign and malignant causes, leading to biliary obstruction and cholangitis.1 Patients are often managed with long-term percutaneous biliary drains, which are associated with pain, obstructions, dislodgements, leakage, and chronic biliocutaneous fistulas.2 Although acute leaks around hepaticojejunal anastomoses are not uncommon, chronic anastomotic dehiscence is very rare but can lead to abscess formation and subsequent fistulization.3 In patients who are deemed poor surgical candidates, can these conditions be treated endoscopically? (Institutional review board approval was obtained for this study.)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 under the mother-baby cholangioscope system using a colonoscope for large common bile duct stones in a patient with Roux-en-Y reconstruction
Electrohydraulic lithotripsy (EHL) is useful for the treatment of common bile duct (CBD) stones (CBDSs) when stones are larger than 2 cm in diameter or conventional extraction methods have proven ineffective.1 However, EHL requires direct visualization of the CBD, which is often challenging in patients who have undergone Roux-en-Y reconstruction. There have been some reports of EHL under direct cholangioscopy using an enteroscope or ultra-slim upper endoscope for patients with a history of Roux-en-Y reconstruction.EUS-guided jejunojejunostomy to facilitate ERCP in a patient with unique Roux-en-Y gastric bypass anatomy
Lumen-apposing metal stents (LAMSs), although initially created for draining pancreatic fluid collections, are frequently used in an “off-label” fashion. They have recently gained popularity as a means to facilitate ERCP in patients with surgically altered GI anatomy. We have previously described using LAMSs to create a temporary gastroenterostomy to facilitate ERCP in a patient with duodenal switch anatomy.1 The present case describes the use of a LAMS to enable ERCP in a patient with a history of vertical sleeve gastrectomy converted to a Roux-en-Y gastric bypass.Fibrous-membrane resection for hepaticojejunostomy anastomosis obstruction under enteroscopic and cholangioscopic double views
Obstruction of hepaticojejunostomy anastomosis (HJA) is a potential adverse event of pancreatoduodenectomy (PD). An occluded HJA is treated by percutaneous transhepatic biliary drainage (PTBD) or surgical/endoscopic procedures.1,2 Endoscopic procedures are less invasive than surgical treatment3 and are compatible with a larger variety of devices than PTBD. However, in cases of occluded HJA, it is extremely difficult to reopen the anastomosis via endoscopy when the membrane is thick and hard because the direction of opening is unknown.Recanalization of the bile duct by using percutaneous and endoscopic methods after iatrogenic injury
Bile leaks are an uncommon adverse event after biliary surgery. Iatrogenic common bile duct (CBD) injuries are particularly uncommon. However, they lead to substantial morbidity and often require surgical intervention, possibly with the creation of Roux-en-Y hepaticojejunostomy. We describe a case demonstrating the successful combination of endoscopic and percutaneous methods to recanalize the bile duct after iatrogenic injury.Biliary reintervention with endoscopic inversion technique in the duodenum with the use of short-type double-balloon endoscope in a patient with an indwelling duodenal stent
Endoscopic biliary and duodenal metallic stent placement is a current mainstay of treatment for combined malignant biliary obstruction (MBO) and gastric outlet obstruction (GOO).1,2 In patients with an indwelling duodenal stent (DuS), endoscopic biliary reintervention is technically challenging, and percutaneous transhepatic biliary drainage (PTBD) is frequently required as a salvage treatment.3-6 However, PTBD can be contraindicated in patients with massive ascites or severe coagulopathy, and is associated with deterioration of quality of life and with an increased risk of adverse events.EUS-guided gastroenterostomy by use of a lumen-apposing metal stent to facilitate ERCP in a patient with duodenal switch anatomy
Lumen-apposing metal stents (LAMSs) have gained popularity in a variety of clinical scenarios. Whereas LAMSs were initially used to drain pancreatic fluid collections, several off-label uses have been developed, including EUS-guided access to facilitate ERCP in patients with surgically altered anatomy. The duodenal switch procedure is a bariatric surgical procedure that induces weight loss by combining a sleeve gastrectomy with an intestinal bypass. This procedure renders the ampulla nearly inaccessible to conventional endoscopic access.EUS biliary drainage with a lumen-apposing metal stent through a pre-existing duodenal metal stent
EUS-guided biliary drainage (EUS-BD) is an alternative procedure to percutaneous transhepatic biliary drainage (PTBD) after ERCP failure. Success rates with EUS-BD are estimated to be around 95%, depending on the endoscopist’s experience, and a recent meta-analysis has demonstrated that EUS-BD provides equivalent technical success with lower rates of adverse events in comparison with PTBD.1-4 There are limited data on EUS-BD in patients with an indwelling duodenal stent; only a few articles have suggested that EUS-BD is safe and effective in this patient population.
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