A Novel Application of a Through the Scope Fully Covered Esophageal Stent for an Endoscopic Ultrasound-Directed Transgastric Endoscopic Retrograde Cholangiopancreatography Procedure
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View abstract on PubMed
Summary
This summary is machine-generated.Endoscopic ultrasound-directed transgastric ERCP (EDGE) helps patients with Roux-en-Y gastric bypass anatomy. A novel technique using an esophageal stent as a ramp successfully enabled access for ERCP in a challenging case.
Area Of Science
- Gastroenterology
- Minimally Invasive Surgery
- Endoscopy
Background
- Traditional endoscopic retrograde cholangiopancreatography (ERCP) poses significant challenges in patients with Roux-en-Y gastric bypass anatomy.
- The endoscopic ultrasound-directed transgastric ERCP (EDGE) procedure has emerged as a less invasive alternative for biliary access in this patient population.
Observation
- A 53-year-old female with Roux-en-Y gastric bypass presented with symptoms of cholelithiasis and cholecystitis.
- During a staged EDGE procedure, a lumen-apposing metal stent (LAMS) was placed, but the duodenoscope could not be cannulated due to efferent loop bowing.
Findings
- A fully covered esophageal stent was deployed through the LAMS, creating a stable ramp.
- This ramp facilitated successful duodenoscope passage, enabling completion of ERCP and removal of gallstones.
Implications
- This case demonstrates an innovative technical modification to overcome common difficulties in accessing LAMS during EDGE procedures.
- The described technique offers a potential solution for improving the success rate of ERCP in patients with altered gastrointestinal anatomy.
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