Post written by Shelini Sooklal, MD, from the Division of Gastroenterology, Hepatology and Nutrition, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
This video case demonstrates the technique of using a disposable gastric overtube device to aid passage of the duodenoscope through a previously placed lumen apposing metal stent (LAMS), from the roux limb to the remnant stomach in a patient with Roux-en-Y anatomy and choledocholithiasis. Due to significant looping in the gastric pouch and Roux limb, the duodenoscope was initially unable to traverse the LAMS, and various other traditional methods to aid duodenoscope passage were unsuccessful.
This case demonstrates a novel use of a commonly stocked endoscopic device. Gastric overtubes are conventionally used for endoscopic procedures requiring foreign body removal from the stomach, or procedures where multiple esophageal intubations may be needed eg, endoscopic submucosal dissection. However, when all other techniques failed, this device aided successful completion of the EUS-directed transgastric ERCP (EDGE) procedure and management of choledocholithiasis.
Know your equipment, and think outside of the box. Familiarize yourself with the devices and accessories commonly stocked in your endoscopy unit. When conventional methods and devices fail to achieve the desired outcome, safely put tools in your armamentarium to new uses to complete the procedure successfully.
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