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EUS-guided biliary drainage in a patient after postcholecystectomy complete biliary transection (with video)

1 Department of Gastroenterology, Saiseikai Shimonoseki General Hospital, Shimonoseki, Yamaguchi, Japan
2 Department of Gastroenterology and Hepatology, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan

Date of Submission21-Nov-2021
Date of Acceptance15-Feb-2022
Date of Web Publication20-Jul-2022

Correspondence Address:
Hirofumi Harima,
Department of Gastroenterology, Saiseikai Shimonoseki General Hospital, 8-5-1 Yasuoka-cho, Shimonoseki, Yamaguchi 759-6603
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/EUS-D-21-00258

PMID: 35899905

How to cite this URL:
Suehiro H, Harima H, Kawano M, Hanazono T, Mori K, Takami T. EUS-guided biliary drainage in a patient after postcholecystectomy complete biliary transection (with video). Endosc Ultrasound [Epub ahead of print] [cited 2022 Dec 1]. Available from: http://www.eusjournal.com/preprintarticle.asp?id=351311

Biliary injury occurs after cholecystectomy in 0.3%–2.7% of patients.[1] Minor injuries can be managed endoscopically, whereas major injuries generally require surgical reconstruction.[2] However, due to the development of EUS-guided biliary drainage (EUS-BD) techniques, endoscopic minimally invasive treatment may be applied even for major injuries. Here, we describe a case of postcholecystectomy complete biliary transection managed endoscopically using the EUS-BD technique.

An 85-year-old man was referred to our hospital for the treatment of severe cholecystitis. He was a bedridden patient with a history of liver cirrhosis and normal-pressure hydrocephalus. We performed subtotal cholecystectomy instead of total cholecystectomy due to severe adhesions and intraoperative bleeding. After the surgery, continuous biliary leakage occurred. Computed tomography showed a small amount of perihepatic ascites. The hilar bile duct was obscured, but the intrahepatic bile ducts were not dilated [Figure 1]a and [Figure 1]b. We attempted endoscopic biliary stenting via ERCP to relieve the biliary pressure. However, we abandoned this approach because cholangiography revealed common bile duct disruption [Figure 2]. Magnetic resonance cholangiopancreatography also revealed complete transection of the common bile duct [Figure 3]. We decided to try endoscopic biliary stenting via EUS-BD because we considered that reoperation for this patient might lead to a poor result [Video 1 [Additional file 1]]. The transected hilar duct was punctured from the duodenum because the B2 and B3 branches were not dilated. Cholangiography showed biliary leakage from the B6 branch. A plastic stent (TYPE-IT stent; Gadelius Medical Co., Ltd., Tokyo, Japan) was placed from the hilar bile duct to the duodenum. No procedure-related complications occurred, and biliary leakage was resolved.
Figure 1: Computed tomography showing a small amount of perihepatic ascites. The hilar bile duct is obscured (arrow). The intrahepatic bile ducts are not dilated. (a) Axial view. (b) Coronal view

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Figure 2: Cholangiography showing common bile duct disruption

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Figure 3: Magnetic resonance cholangiopancreatography showings complete transection of the common bile duct (arrows)

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Surgical reconstruction for biliary injury was associated with a high morbidity rate of 20%–31%.[2] Endoscopic biliary stenting via EUS-BD can serve as a minimally invasive treatment option for patients with poor general conditions.

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 initials will not be published and due efforts will be made to conceal his identity, but anonymity cannot be guaranteed.

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Conflicts of interest

There are no conflicts of interest.

  References Top

Rio-Tinto R, Canena J. Endoscopic treatment of post-cholecystectomy biliary leaks. GE Port J Gastroenterol 2021;28:265-73.  Back to cited text no. 1
Schreuder AM, Nunez Vas BC, Booij KA, et al. Optimal timing for surgical reconstruction of bile duct injury: Meta-analysis. BJS Open 2020;4:776-86.  Back to cited text no. 2


  [Figure 1], [Figure 2], [Figure 3]


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