Abstract
A 90-year-old woman was admitted to our hospital for acute cholangitis due to choledocholithiasis. We attempted to perform endoscopic biliary drainage (EBD) using a side-viewing duodenal endoscope (outer diameter 13.5 mm). However, a membranous stricture at the esophageal orifice hindered insertion of the endoscope. Nevertheless, it was possible to pass a small-caliber endoscope (outer diameter 5.5 mm, working channel 2.0 mm) through the stricture and advance it into the duodenum. After deep biliary cannulation, a guidewire was advanced into the bile duct. Endoscopic cholangiography showed bile duct dilatation and a bile duct stone (diameter 18mm). Finally, a 5-Fr biliary stent that had been made from an endoscopic naso-biliary drainage tube (5-Fr pig tail type) was placed. Hence, EBD using a small-caliber endoscope may be a useful technique for the treatment of acute cholangitis in patients with digestive tract obstruction.
