Tsukasa Ikeura, MD, PhD from the Third Department of Internal Medicine, Kansai Medical University, in Osaka, Japan shares this video case from the VideoGIE section, “Reintervention for an occluded metal stent under the guidance of peroral direct cholangioscopy by using an ultra-slim enteroscope.”
A patient who had undergone partial gastrectomy with Roux-en-Y gastrojejunostomy for gastric carcinoma suffered from obstructive jaundice due to a hilar biliary stricture resulting from lymph node metastasis underwent suprapapillary placement of an uncovered metallic stent by use of a double-balloon enteroscope. Four months after metallic stent deployment, the patient presented with recurrent obstructive jaundice, because of stent occlusion caused by tumor ingrowth. We intended to place an additional metallic stent; however, we could not easily insert a guidewire through the lumen of the stent under radiographic guidance. Therefore, after the a double-balloon enteroscope was removed with the overtube left in place, an ultra-slim colonoscope was inserted into the biliary duct through the overtube. Occlusion of the metallic stent caused by marked tumor ingrowth was directly demonstrated, and we could easily perform the wire passage through the lumen of the stent and subsequently placed an additional metallic stent by the stent-in-stent method.
When the transpapillary reintervention for an occluded metallic stent is performed, the wire passage through the stent of the occluded stent is occasionally complicated for various reasons such as severe narrowing of the stent lumen and distortion of the biliary duct. In particular, in ERCP using a double-balloon enteroscope, it may be even more difficult owing to the instability and insufficient maneuverability of the double-balloon enteroscope. In our case, the peroral direct cholangioscopy made the wire passage easier.
A use of peroral direct cholangioscopy is useful in the wire passage through the occluded metallic stent.
Find more VideoGIE cases online.
The information presented in Endoscopedia reflects the opinions of the authors and does not represent the position of the American Society for Gastrointestinal Endoscopy (ASGE). ASGE expressly disclaims any warranties or guarantees, expressed or implied, and is not liable for damages of any kind in connection with the material, information, or procedures set forth.