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DOI: 10.1055/s-0043-119971
Electronic hydraulic lithotripsy by antegrade digital cholangioscopy through endoscopic ultrasound-guided hepaticojejunostomy
Corresponding author
Publikationsverlauf
Publikationsdatum:
09. Oktober 2017 (online)
This report describes antegrade electronic hydraulic lithotripsy (Lithotron EL 27; Walz Elektronik, Rohrdorf, Germany) using a digital peroral cholangioscope (SpyGlass DS System; Boston Scientific, Marlborough, Massachusetts, USA) [1] [2] through an endoscopic ultrasound (EUS)-guided hepaticojejunostomy route for common bile duct (CBD) stones ([Video 1]).
Video 1 Antegrade electronic hydraulic lithotripsy using a digital peroral cholangioscope through an endoscopic ultrasound-guided hepaticojejunostomy fistula. This novel method could become a rescue procedure when the conventional transpapillary approach is unsuccessful.
Qualität:
A 77-year-old man, who underwent total gastrectomy with a Roux-en-Y procedure for gastric cancer, presented with cholangitis caused by CBD stones. Endoscopic transpapillary drainage was attempted, but the scope could not be inserted into the ampulla; therefore, EUS-guided hepaticojejunostomy was performed.
From the Roux-en-Y jejunum, the dilated intrahepatic bile duct was punctured with a 19-gauge needle under EUS. After guidewire insertion toward the distal bile duct, the puncture site was dilated using a balloon dilator (diameter 4 mm, REN; Kaneka Medix, Osaka, Japan) ([Fig. 1]). A covered metal stent (diameter 8 mm, length 8 cm, Niti-S; Taewoong Medical, Gyeonggi-do, South Korea) was inserted between the intrahepatic bile duct and the Roux-en-Y jejunum ([Fig. 2]). The following day, the patient’s cholangitis was markedly improved, and he was discharged 3 days after surgery.
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The patient was re-admitted to our hospital 4 weeks later to continue treatment for CBD stones. The cholangioscope was inserted over the guidewire through the metal stent ([Fig. 3]), and the CBD stones were revealed by cholangioscopy ([Fig. 4 a]). The stones were crushed by electronic hydraulic lithotripsy ([Fig. 4 b]). Subsequently, the metal stent was removed and a balloon dilator was inserted into the fistula toward the ampulla and dilated up to 12 mm ([Fig. 5 a]). The CBD stones were pushed out into the digestive tract in an antegrade fashion using a balloon catheter ([Fig. 5 b]). Finally, a single-pigtail plastic stent (7 Fr, 20 cm length) [3] was deployed between the CBD and the Roux-en-Y jejunum ([Fig. 6]). The patient resumed eating 4 days after surgery with no adverse effects, and was discharged 7 days after surgery.
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Endoscopy_UCTN_Code_TTT_1AR_2AH
Endoscopy E-Videos is a free access online section, reporting on interesting cases and new techniques in gastroenterological endoscopy. All papers include a high quality video and all contributions are freely accessible online.
This section has its own submission website at https://mc.manuscriptcentral.com/e-videos
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Competing interests
None
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References
- 1 Navaneethan U, Hasan MK, Kommaraju K. et al. Digital, single-operator cholangiopancreatoscopy in the diagnosis and management of pancreatobiliary disorders: a multicenter clinical experience (with video). Gastrointest Endosc 2016; 84: 649-655
- 2 Tanaka R, Itoi T, Honjo M. et al. New digital cholangiopancreatoscopy for diagnosis and therapy of pancreaticobiliary diseases (with videos). J Hepatobiliary Pancreat Sci 2016; 23: 220-226
- 3 Umeda J, Itoi T, Tsuchiya T. et al. A newly designed plastic stent for EUS-guided hepaticogastrostomy: a prospective preliminary feasibility study (with videos). Gastrointest Endosc 2015; 82: 390-396
Corresponding author
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References
- 1 Navaneethan U, Hasan MK, Kommaraju K. et al. Digital, single-operator cholangiopancreatoscopy in the diagnosis and management of pancreatobiliary disorders: a multicenter clinical experience (with video). Gastrointest Endosc 2016; 84: 649-655
- 2 Tanaka R, Itoi T, Honjo M. et al. New digital cholangiopancreatoscopy for diagnosis and therapy of pancreaticobiliary diseases (with videos). J Hepatobiliary Pancreat Sci 2016; 23: 220-226
- 3 Umeda J, Itoi T, Tsuchiya T. et al. A newly designed plastic stent for EUS-guided hepaticogastrostomy: a prospective preliminary feasibility study (with videos). Gastrointest Endosc 2015; 82: 390-396
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