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Create a Free AccountProcedures - Endoscopic ultrasound (EUS) - therapeutic
Endoscopic ultrasound-guided pancreaticoduodenostomy with a forward-viewing echoendoscope
A 76-year-old man with distal bile duct cancer was treated by endoscopic transpapillary self-expandable metallic stent placement and hospice care. He had undergone liver resection for hepatocellular carcinoma 4 years prior. He presented with sudden-onset epigastric pain and vomiting. CT revealed a main pancreatic duct (MPD) stricture in the head of the pancreas, and upstream ductal dilation (Fig. 1). A blood test revealed elevated pancreatic enzymes (amylase 554, lipase 781), and he was diagnosed with acute pancreatitis secondary to malignant pancreatic duct obstruction.Novel forward-viewing EUS-guided ileoureterostomy technique for recurrent pyelonephritis caused by ureteral stenosis
Recently, EUS-guided fistulotomy has been widely applied during treatment for diseases of the bile duct,1 gallbladder,2 and pancreatic duct3 in addition to walled-off necrosis,4 but apparently it has not been applied to the ureter. This report describes our experience with EUS-guided ileoureterostomy to treat recurrent pyelonephritis caused by right-sided ureteral stenosis, complicated by the inability to pass a percutaneous guidewire (Video 1, available online at www.VideoGIE.org ).Successful EUS-guided retrograde pancreatic duct stent placement for refractory pancreaticojejunostomy stricture after pancreaticoduodenectomy with a forward-viewing echoendoscope
A 62-year-old man underwent pancreaticoduodenectomy with modified Child reconstruction for a duct-type intraductal papillary mucinous neoplasm localized at the pancreatic head. One year later, he was admitted because of pancreatitis associated with pancreaticojejunostomy stricture (PJS). We performed ERCP with a small-caliber colonoscope, successfully identified the anastomosis, and cannulated the pancreatic duct. Then, we dilated the PJS using a balloon catheter and deployed a 5F plastic stent.
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