Correspondence Address: Dr. Takeshi Ogura 2nd Department of Internal Medicine, Osaka Medical College, 2-7 Daigakuchou, Takatsukishi, Osaka 569-8686 Japan
Source of Support: None, Conflict of Interest: None
How to cite this article: Ogura T, Ueno S, Nishioka N, Yamada M, Higuchi K. Fine-gauge balloon-assisted stent removal technique for ruptured EUS-guided hepaticojejunostomy plastic stents (with video). Endosc Ultrasound 2020;9:143-5
How to cite this URL: Ogura T, Ueno S, Nishioka N, Yamada M, Higuchi K. Fine-gauge balloon-assisted stent removal technique for ruptured EUS-guided hepaticojejunostomy plastic stents (with video). Endosc Ultrasound [serial online] 2020 [cited 2021 Sep 20];9:143-5. Available from: http://www.eusjournal.com/text.asp?2020/9/2/143/279425
EUS-guided biliary drainage has been widely attempted for failed endoscopic retrograde cholangiopancreatography., For patients with surgically altered anatomy such as the Roux-en-Y procedure, EUS-guided hepaticojejunostomy (HJS) is performed. A covered self-expandable metal stent with a long length is normally used as an EUS-HGS stent to prevent stent migration,, but if this stent is used in EUS-HJS, collateral injury of the jejunal mucosa may occur. Therefore, a novel long plastic stent (Type IT stent; Gadelius Medical Co., Ltd., Tokyo, Japan) is used as an EUS-HJS stent [Figure 1]. This plastic stent has a total length of 20 cm, an effective length of 15 cm, and 4 flanges. Among four flanges, two are at the distal and another at the proximal ends. The proximal end has a pigtail structure and the distal end is tapered. A disadvantage of the plastic stent is the risk of rupture during stent removal. This report describes balloon-assisted stent removal for a ruptured plastic stent using a balloon catheter (4 mm, REN biliary dilation catheter; KANEKA, Osaka, Japan), which top was 3 Fr. An 80-year-old male underwent total gastrectomy with the Roux-en-Y procedure due to gastric cancer 2 years earlier. During clinical follow-up, obstructive jaundice developed due to malignant peritonitis of recurrent gastric cancer. He underwent EUS-guided antegrade metal stent deployment combined with EUS-HJS using a Type IT stent [Figure 2]. A Type IT stent was deployed form the common bile duct to the intestine. Clinical follow-up was performed using laboratory examination every 2 months. However, after 6 months, he was admitted because of cholangitis due to stent occlusion. EUS-HJS removal using a forceps biopsy device was attempted after safety guidewire placement, but the plastic stent was ruptured [Figure 3]. To prevent stent migration into the biliary tract and rerupture, a 0.025-inch guidewire was inserted into the Type IT stent [Figure 4]. Then, a fine-gauge balloon catheter was inserted into the Type IT stent over the guidewire [Figure 5], and stent removal was successfully performed [Figure 6]. Finally, the Type IT stent was deployed from the intrahepatic bile duct to the intestine [Video 1]. The fine-gauge balloon-assisted stent removal technique may be safe and useful for cases such as the present one.
Figure 1: A dedicated plastic stent for EUS-guided transhepatic biliary drainage
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