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 Table of Contents  
IMAGES AND VIDEOS
Year : 2020  |  Volume : 9  |  Issue : 2  |  Page : 143-145

Fine-gauge balloon-assisted stent removal technique for ruptured EUS-guided hepaticojejunostomy plastic stents (with video)


2nd Department of Internal Medicine, Osaka Medical College, Osaka, Japan

Date of Submission01-Nov-2019
Date of Acceptance24-Dec-2019
Date of Web Publication25-Feb-2020

Correspondence Address:
Dr. Takeshi Ogura
2nd Department of Internal Medicine, Osaka Medical College, 2-7 Daigakuchou, Takatsukishi, Osaka 569-8686
Japan
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/eus.eus_79_19

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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.[1],[2] 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,[3],[4] but if this stent is used in EUS-HJS, collateral injury of the jejunal mucosa may occur.[5] 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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Figure 2: EUS-guided antegrade-covered metal stent deployment is performed, and plastic stent deployment is also performed from the bile duct to the intestine

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Figure 3: The plastic stent is ruptured during stent removal

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Figure 4: The 0.025-inch guidewire is inserted into the ruptured plastic stent

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Figure 5: A fine-gauge balloon catheter is inserted into the ruptured plastic stent over the guidewire

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Figure 6: Stent removal is successfully performed

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Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given his consent for his images and other clinical information to be reported in the journal. The patient understands that his name and initial will not be published, and due efforts will be made to conceal his identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Isayama H, Nakai Y, Itoi T, et al. Clinical practice guidelines for safe performance of endoscopic ultrasound/ultrasonography-guided biliary drainage: 2018. JHepatobiliary Pancreat Sci 2019;26:249-69.  Back to cited text no. 1
    
2.
Kahaleh M, Artifon EL, Perez-Miranda M, et al. EUS-guided drainage: Summary of therapeutic EUS consortium meeting. Endosc Ultrasound 2019;8:151-60.  Back to cited text no. 2
    
3.
Ogura T, Yamamoto K, Sano T, et al. Stent length is impact factor associated with stent patency in endoscopic ultrasound-guided hepaticogastrostomy. JGastroenterol Hepatol 2015;30:1748-52.  Back to cited text no. 3
    
4.
Nakai Y, Isayama H, Yamamoto N, et al. Safety and effectiveness of a long, partially covered metal stent for endoscopic ultrasound-guided hepaticogastrostomy in patients with malignant biliary obstruction. Endoscopy 2016;48:1125-8.  Back to cited text no. 4
    
5.
Ogura T, Higuchi K. Technical tips for endoscopic ultrasound-guided hepaticogastrostomy. World J Gastroenterol 2016;22:3945-51.  Back to cited text no. 5
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]



 

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