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Endoscopic Ultrasound-Guided Biliary Drainage: Endoscopic Ultrasound-Guided Hepaticogastrostomy in Malignant Biliary Obstruction
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Endoscopic Biliary Intervention Using Traction Devices for Periampullary Diverticulum.

Ryuji Inoue1, Hiroshi Kawakami2,3, Yoshimasa Kubota2,3

  • 1Department of Internal Medicine, Kushima Municipal Hospital, Japan.

Internal Medicine (Tokyo, Japan)
|June 11, 2019
PubMed
Summary

This study highlights a novel technique using traction devices to overcome challenges in biliary interventions caused by periampullary diverticulum. This method enabled successful endoscopic retrograde cholangiopancreatography, sphincterotomy, and stone extraction in an elderly patient.

Keywords:
choledocholithiasisendoscopic biliary interventionendoscopic clipperiampullary diverticulumtraction devices

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Area of Science:

  • Gastroenterology
  • Endoscopic procedures

Background:

  • Periampullary diverticulum (PAD) poses a significant challenge for endoscopic retrograde cholangiopancreatography (ERCP).
  • Difficulties in visualizing the ampulla of Vater can impede standard biliary interventions.

Observation:

  • A 92-year-old woman presented with choledocholithiasis and a periampullary diverticulum.
  • Initial ERCP attempts were complicated by poor visualization of the papilla of Vater.

Findings:

  • A 7-Fr plastic stent was successfully placed during the initial ERCP session.
  • Utilizing traction devices 15 days later improved visualization of the papilla.
  • Subsequent endoscopic sphincterotomy and common bile duct stone extraction were performed without complications.

Implications:

  • Traction devices may be a valuable tool for improving visualization during ERCP in patients with PAD.
  • This technique can facilitate successful endoscopic biliary interventions in challenging anatomical situations.
  • The application of traction devices shows promise for complex endoscopic submucosal dissection and biliary procedures.