A case of choledocholithiasis treated by parallel cannulation along with PTGBD rendezvous

Area of Science:

• Gastroenterology and Hepatology
• Interventional Endoscopy

Background:

• Choledocholithiasis presents a significant challenge, particularly with complex biliary anatomy.
• Large duodenal diverticula can impede standard endoscopic retrograde cholangiography (ERC) access.
• Percutaneous transhepatic gallbladder drainage (PTGBD) is an established method for biliary decompression.

Purpose of the Study:

• To describe a novel endoscopic approach for treating choledocholithiasis in a patient with large duodenal diverticula.
• To demonstrate the utility of an extended PTGBD tube in facilitating bile duct stone extraction.

Main Methods:

• A case of choledocholithiasis with large duodenal diverticula was managed.
• Initial PTGBD was performed, followed by ERC which revealed a tortuous bile duct precluding stone removal.
• The PTGBD tube was extended into the duodenal lumen to straighten the bile duct, enabling stone extraction.

Main Results:

• The modified technique successfully straightened the challenging lower bile duct anatomy.
• Bile duct stones were effectively removed through the ampulla without complications.
• This approach overcame the limitations of standard ERC in this complex case.

Conclusions:

• Endoscopic management of choledocholithiasis can be achieved even with difficult biliary anatomy and duodenal diverticula.
• The parallel cannulation method combined with an extended PTGBD tube offers a viable solution for challenging bile duct stone removal.
• This technique expands the endoscopic treatment options for complex biliary conditions.