Conversion of a dysfunctional choledochoduodenostomy to transpapillary drainage via a trans-lumen-apposing metal stent choledochoduodenoscopy

eyJraWQiOiI4ZjUxYWNhY2IzYjhiNjNlNzFlYmIzYWFmYTU5NmZmYyIsImFsZyI6IlJTMjU2In0.eyJzdWIiOiIwNTIxMWM5ZjI3NDI4NjcyODYwY2Y5ZjkzNjQ4YjRiMiIsImtpZCI6IjhmNTFhY2FjYjNiOGI2M2U3MWViYjNhYWZhNTk2ZmZjIiwiZXhwIjoxNjkwMTEwMjUzfQ.lDNlWKYe9eXOlwxxuMxB2P-JmflBwHZf1L273LfyKXtPJFNqMTR3YLZwR8VQiYyf3MpEH2TjDJVTPyoi2RVxEZ_x4fi_F-cXKwgH1HADy2rBXuZO2e4_SlHfOphz0ROiQtrYa6kxP5wBUoAsT6jbCMPhbfKVomMAmAtoy6mlstwvjWKSeMp7vG_YKSahiFXYoVtsATTFp_8r2i_U_2juSyMMqUwvseJkaDfHm4VVLpeAibtt-K04cJuuUXwPRNx2MH6pPW9t3ScLR1f9rKCtI2TF4NXcb5W-anfE40bqvQMbpUK1jt_V0Eh7SSzoBJS3VgJQlxKBEI3yWw3MDvyY8w(mp4, (111.54 MB) Download video Peroral antegrade cholangioscopy-guided conversion of dysfunctional choledochoduodenostomy to transpapillary drainage via trans-LAMS (lumen-apposing metal stent). Recurrent biliary obstruction, as a stent dysfunction parameter, is major issue consider after EUS using lumen-apposing stents (LAMSs). Several cases (eg, food or sludge impaction, tumoral invasion, migration, and sump syndrome) have been documented, suggesting possible limitation in LAMS design when performed.1Vanella G. Bronswijk M. Dell'Anna et al.Classification, risk factors, management lumen apposing during follow-up endoscopic ultrasound-guided choledochoduodenostomy: Multicenter evaluation from the Leuven-Amsterdam-Milan Study Group.Dig Endosc. 2023; 35: 377-388Google Scholar,2Garcia-Sumalla A. Loras C. Guarner-Argente al.Is coaxial plastic within useful for distal malignant obstruction?.Surg 2021; 4873-4881Google Scholar A 75-year-old woman with obstruction secondary borderline pancreatic neoplasm failed ERCP because ampulla infiltration underwent EUS-guided (8- × 8-mm + 7F 5-cm pigtail). Because (sump syndrome type) requiring several admissions, was considered. During hospital admission acute cholecystitis, patient percutaneous cholecystostomy by radiology department. Although an interventional radiologist available on duty has potential role our institution, this scenario, decision perform fully made, taking advantage pre-existing (over cholecystostomy). The pigtail removed guidewire advanced antegradely toward papilla therapeutic gastroscope, without success (failed rendezvous) (Fig. 1). No attempt at stenting through made angulation into lower common bile duct. Therefore, peroral rendezvous preferred. First, cholangioscope insertion (through LAMS, gastroscope) done direction. facilitates control desired direction, which allows advancement 0.025-inch stenosis up duodenal lumen. Scope progression over exerted bougie effect against tumor 2). Second, we withdrew gastroscope exchanged them duodenoscope. duodenoscope should be inserted until one can visualize previously guidewire. Retrograde cannulation precut (needle-knife) monorail technique (homemade modified 3.9F sphincterotome3Martínez B. Martínez J. Casellas J.A. al.Endoscopic benign disorders 22-gauge needle 0.018-inch guidewire.Endosc Int Open. 2019; 7: E1038-E1043Google Scholar) intrahepatic radicals 3). Finally, carried out partially covered self-expandable stent; placed its proximal cup just choledochoduodenostomy, allowing removal 4; Video 1, online www.videogie.org).Figure 4Fluoroscopy image showing both stents. Transpapillary stent, (choledochoduodenostomy).View Large Image Figure ViewerDownload Hi-res (PPT) Procedure duration 1 hour. Prophylactic antibiotics were administered, no adverse events reported. Clinical improvement allowed assessment chemotherapy, but malignancy left unfit surgery. This case recurrent caused (choledochoduodenostomy) potentially surgical patient. transmural planned technically performed incidents anterograde cholangioscopy. Dr Gornals consultant Boston Scientific received research grant Fujifilm. other authors disclosed financial relationships. acknowledge CERCA Programme/Generalitat de Catalunya institutional support. recruited randomized trial (multicenter study [BAMPI trial: open-label, controlled protocol; ClinicalTrials.gov: NCT04595058]). also institutions scientific societies that provided support grants BAMPI (Sociedad Española Endoscopia Digestiva Societat Catalana Digestologia). eyJraWQiOiI4ZjUxYWNhY2IzYjhiNjNlNzFlYmIzYWFmYTU5NmZmYyIsImFsZyI6IlJTMjU2In0.eyJzdWIiOiIwNTIxMWM5ZjI3NDI4NjcyODYwY2Y5ZjkzNjQ4YjRiMiIsImtpZCI6IjhmNTFhY2FjYjNiOGI2M2U3MWViYjNhYWZhNTk2ZmZjIiwiZXhwIjoxNjkwMTEwMjUzfQ.lDNlWKYe9eXOlwxxuMxB2P-JmflBwHZf1L273LfyKXtPJFNqMTR3YLZwR8VQiYyf3MpEH2TjDJVTPyoi2RVxEZ_x4fi_F-cXKwgH1HADy2rBXuZO2e4_SlHfOphz0ROiQtrYa6kxP5wBUoAsT6jbCMPhbfKVomMAmAtoy6mlstwvjWKSeMp7vG_YKSahiFXYoVtsATTFp_8r2i_U_2juSyMMqUwvseJkaDfHm4VVLpeAibtt-K04cJuuUXwPRNx2MH6pPW9t3ScLR1f9rKCtI2TF4NXcb5W-anfE40bqvQMbpUK1jt_V0Eh7SSzoBJS3VgJQlxKBEI3yWw3MDvyY8w .mp4 Help files 1Peroral