Endoscopic ultrasound-guided biliary drainage using a forward-viewing echoendoscope for severe anastomotic stenosis of choledochojejunostomy after pancreaticoduodenectomy

Abstract

A 65 year-old female was suspected of having anastomotic stenosis of choledochojejunostomy and cholangitis after subtotal stomach-preserving pancreaticoduodenectomy. Although double-balloon endoscopy was performed, the anastomosis could not be identified. Therefore percutaneous transhepatic biliary drainage was attempted for the purpose of performing the rendez-vous technique, but the guidewire could not pass the stenosis. Double-balloon endoscopy was repeated, and after the endoscope reached the anastomosis, it was replaced with a forward-viewing echoendoscope using a 0.052 inch hard guidewire for the shaft. Endoscopic ultrasound-guided biliary drainage was then performed by using the forward-viewing echoendoscope to directly puncture the common bile duct from the anastomosis. After the balloon dilation, two 7-Fr plastic stents were placed. The procedures were successfully completed without any complications. The stents were removed 3 months later. In summary, we report a new salvage technique for severe anastomotic stenosis of choledochojejunostomy after failed double-balloon endoscopic retrograde cholangiography.