2023 Volume 102 Issue 1 Pages 127-130
The patient was a 55-year-old man who developed acute cholangitis with intrahepatic bile duct stones due to hepaticojejunostomy anastomotic stricture after subtotal stomach-preserving pancreatoduodenectomy. As an initial treatment, single balloon enteroscopy-assisted ERCP (SBE-ERCP) was performed, but the anastomosis site could not be identified. Thus, temporary EUS-guided hepaticogastrostomy was performed for biliary drainage with a 7 Fr plastic stent. After improvement of cholangitis, re-SBE-ERCP was performed, and the catheter was successfully inserted into the bile duct targeting the previously implanted plastic stent by applying the EUS-rendezvous technique (EUS-RV), and a 7 Fr plastic stent was placed through the anastomosis to the anterior and posterior of the right intrahepatic branches. In addition, a covered self-expandable metallic stent was placed in the left hepatic duct. Approximately 3 months after placement of the stent, the intrahepatic bile duct stones initially observed had disappeared, and upon stent removal, a firm fistula was created. The patient had no recurrence until 10 months after stent removal. In conclusion, EUS-RV may be a useful salvage procedure in cases where the anastomosis site cannot be identified.
